gms | German Medical Science

Introduction: Radical surgical resection remains the single-most important treatment in the curative multimodal therapy of soft-tissue sarcomas. In addition adjuvant radiation is frequently performed. Chemotherapy plays a minor role, mostly in palliative settings. Refinements in surgical techniques have resulted in the development of function preserving approaches, such as compartmental resection and wide excision, thus increasing reconstructive demands.

Material and methods: The present study retrospectively reviews records of all patients (n=26) who underwent microsurgical reconstruction subsequent to soft-tissue sarcoma resection from 1999 to 2006. 26 patients with a mean age of 58 (range: 22–85y) received a total of 27 free flaps. Free flaps utilized included: radial forearm flap (n=2), osteocutaneous fibula flap (n=2), musculocutaneous latissimus dorsi flap (n=8), rectus abdominis flap (n=5), lateral arm flap (n=5), anterolateral thigh flap (n=4) and parascapular flap (n=1). All patients had tissue defects related to soft tissue sarcoma resection.

Results: Major complications defined as total flap loss, partial flap loss or dehiscence with consecutive delayed therapy were encountered in 3 cases (11,1%) including one patient with complete flap loss requiring an additional free flap (3,7%). Minor complications, defined as wound dehiscences not resulting in delay of therapy, were observed in 2 patients (7,4%). The overall complication rate including major and minor complications was 18,5%. Extremity salvage could be achieved in all patients with extremity tumors (n=21). Complete tumor resection was obtained in 96,2%, one patient required re-excision ultimately resulting in R0 resection status.

Conclusion: Crucial in therapeutical management of soft-tissue sarcomas is a synergetic interdisciplinary approach including Diagnostic Radiology, Plastic Surgery, Orthopedic Surgery, Medical Oncology and Radiation Oncology. Plastic Surgery contributes by offering microsurgical reconstruction using free tissue transfer. This allows both, adequate oncosurgical resection and function preservation. Thus, free tissue transfer has become a reliable, versatile and often indispensable surgical option in the management of soft-tissue sarcomas.