Single Stage Oncologic Resection and Reconstruction: A Step toward Development of Sarcoma Service in Resource Constrained Country

Abstract

Tumor free-margin surgical resection remains the single most important treatment in the curative therapy of musculoskeletal tumor of limbs. Refinements in surgical techniques have led to increased function preservation and limb salvage. Patients and Methods: The records of patients (n = 24) who underwent microsurgical soft tissue reconstruction subsequent to resection of limb tumour during the period 2006 to 2011 were reviewed. Primary outcome i.e. uptake of the flap was evaluated. Perioperative morbidities were also noted including donor as well as recipient site complications. Assessment of Functional outcome (Musculoskeletal Tumor Society score, MSTS) local recurrence, free survival, and disease-specific survival was also made. Results: Twenty four patients (age range: 7 - 72 years) who have undergone tumor resection followed by flap coverage were identified. Lower limb reconstruction outnumbered upper limb by 6:1. Complications included, one complete failure of free vascularized iliac crest flap done for reconstruction of a heel defect. One of the patients had secondary hemorrhage 10 days after surgery. Another patient with internal hemipelvectomy for Ewing’s sarcoma had a dura puncture during resection of sacrum. Partial epidermal necrosis was evident in four cases. Eighty three percent of the patients remained alive (n = 20), 19 of whom currently have no evidence of disease (NED) Disease recurrence was noted in three patients. Overall MSTS score was 73.5%. Conclusion: The microsurgical repair of defects is a reliable option that, though not free of complications, is necessary in selected cases. The procedure enables both adequate oncosurgical resection and function preservation.