Soft tissue reconstruction after lower extremity limb-sparing pediatric sarcoma resection

Abstract

Aim: Limb salvage is the treatment of choice for lower extremity bone sarcomas in children. To date, peers have not described algorithms for soft tissue reconstruction of these defects. This paper is to report a large single center series of lower extremity salvage after sarcoma treatment, with algorithm.

Methods: The authors performed a retrospective review of patients undergoing resection of lower extremity bone sarcomas at a single center over 12 years.

Results: In total, 65 children (29 girls, 36 boys) with a mean age of 13 years (range 2.9-23.3 years) underwent resection of a lower leg sarcoma with limb-salvage. Tumors types included 50 osteosarcomas, and 15 Ewing sarcoma family of tumors. The types of reconstruction utilized included: 34 primary closures, 22 gastrocnemius and soleus flaps, 3 bipedicled flaps, 2 sural artery flaps, 1 pedicled anterolateral thigh flap, 3 pedicled posterior thigh flaps for subsequent above-knee amputations. No free flap based reconstructions were performed. An algorithm for reconstruction of leg defects in the setting of limb-salvage surgery is presented. Successful limb salvage rate was 95.4%. Limb salvage failed in 3 patients and they required amputation. Finally, 56 patients were able to ambulate without assistance at last follow-up.

Conclusion: The authors present an algorithm for the reconstruction soft tissue after resection of lower extremity bone sarcomas. The use of these techniques helps to decrease complications and maximize function in children with these tumors.

Keywords

Pediatric / bone sarcoma / limb-salvage surgery / reconstruction

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