The free innervated latissimus dorsi flap for functional reconstruction following soft tissue sarcoma resection of the posterior compartment of the thigh

Abstract

Soft tissue sarcoma (STS) surgery has evolved significantly over the last half a century. From amputation to limb-salvage and limb-sparing surgery, reconstructive demands have continuously increased in an effort to provide the best function-preserving disease-free outcome. Given STS typically affect the limbs more so than any other region of the body, restoration of function whilst not important oncologically is critical to incorporate in the reconstructive plan of any onco-plastic team. The use of loco-regional flaps as well as free flaps provides the mainstay of reconstructive options. The next advance in the reconstructive journey in this clinical area is the use of innervated flaps to restore function. Between 2011 and 2016, all patients who underwent sarcoma extirpation from the posterior thigh and reconstruction using a free innervated latissimus dorsi flap were prospectively identified and a case note review was performed. In this series, 7 patients have undergone free flap reconstruction of the thigh posterior compartment achieving MRC (medical research council, UK) grade M5 power restoration in 6/7 patients. The authors believe this technique to be hugely valuable in the surgical armamentarium of the reconstructive plastic surgeon in order to achieve the best functional outcomes in such a cohort of patients. Level of Evidence: Level IV, therapeutic study.