Complex reconstruction of the lower extremity following sarcoma resection: a literature review

Beina Azadgoli , Antoine L. Carre , David P. Perrault , Alex K. Wong

Plastic and Aesthetic Research ›› 2018, Vol. 5 ›› Issue (1) : 3

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Plastic and Aesthetic Research ›› 2018, Vol. 5 ›› Issue (1) :3 DOI: 10.20517/2347-9264.2017.32
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Complex reconstruction of the lower extremity following sarcoma resection: a literature review

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Abstract

While amputation was traditionally the only option available for patients with sarcomas of the extremities, chemotherapy, radiation, and advances in microsurgical technique have allowed many patients to undergo limb-salvaging procedures. Given the low incidence and heterogeneity of these tumors, there is currently no standard treatment algorithm for limb reconstruction after large sarcoma resection. Thus, we systematically reviewed the various types of free tissue transfer used for the reconstruction of lower limbs after sarcoma resection. Techniques were described based on anatomic location. This literature review supports free tissue transfer as a safe and acceptable modality for reconstruction after sarcoma resection of the lower limb. It allows for the application of healthy vascularized tissue to the defect while also providing freedom of flap positioning. Flap choice is dependent on tumor and defect size, tissue type and function, as well as donor site availability.

Keywords

Lower extremity / sarcoma / reconstruction

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Beina Azadgoli, Antoine L. Carre, David P. Perrault, Alex K. Wong. Complex reconstruction of the lower extremity following sarcoma resection: a literature review. Plastic and Aesthetic Research, 2018, 5(1): 3 DOI:10.20517/2347-9264.2017.32

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References

[1]

Swallow CJ.Local management of adult soft tissue sarcomas..Semin Oncol2007;34:256-69

[2]

Lopez JF,Kaartinen IS,Pakarinen TK,Kuokkanen H.Primary flap reconstruction of tissue defects after sarcoma surgery enables curative treatment with acceptable functional results: a 7-year review..BMC Surg2015;15:71 PMCID:PMC4460917

[3]

Nijhuis PH,Otter R,van der Graaf WT.Epidemiological aspects of soft tissue sarcomas (STS) - consequences for the design of clinical STS trials..Eur J Cancer1999;35:1705-10

[4]

Pollock RE,Winchester DP.The National Cancer Data Base report on soft tissue sarcoma..Cancer1996;15:2247-57

[5]

Abramson DL,Singer S,Pribaz JJ.Single-stage, multimodality treatment of soft-tissue sarcoma of the extremity..Ann Plast Surg1997;39:454-60

[6]

Cordeiro PG,Hidalgo DA.The role of free tissue transfer following oncologic resection in the lower extremity..Ann Plast Surg1994;33:9-16

[7]

Serletti JM,O'Keefe RJ.Functional outcome after soft-tissue reconstruction for limb salvage after sarcoma surgery..Plast Reconstr Surg1998;102:1584-5

[8]

Heiner J,Mott W.Immediate free tissue transfer for distal musculoskeletal neoplasms..Ann Plast Surg1993;30:140-6

[9]

Barner-Rasmussen I,Bohling T,Sampo M.Microvascular reconstruction after resection of sarcoma of the leg..Br J Surg2009;96:482-9

[10]

Leow AM,Wan Z.Reconstructive treatment following resection of high-grade soft-tissue sarcomas of the lower limb..J Orthop Surg (Hong Kong)2005;13:58-63

[11]

Momeni A,Stark GB.The use of the anterolateral thigh flap for microsurgical reconstruction of distal extremities after oncosurgical resection of soft-tissue sarcomas..J Plast Reconstr Aesthetic Surg2011;64:643-8

[12]

Rudiger HA,Choong PF.Surgical outcome of soft tissue sarcomas of the adductor compartment..J Orthop Surg (Hong Kong)2009;17:284-7

[13]

Fortner JG,Shiu MH.Limb-preserving vascular surgery for malignant tumors of the lower extremity..Arch Surg1977;112:391-4

[14]

Muramatsu K,Miyoshi T,Taguchi T.Clinical outcome of limb-salvage surgery after wide resection of sarcoma and femoral vessel reconstruction..Ann Vasc Surg2011;25:1070-7

[15]

Ng RW,Mok V.A modification of technique to cover a large posterior thigh defect using an anterolateral thigh flap..Ann Plast Surg2008;61:201-3

[16]

Zbuchea A.Lateral genicular artery flap for reconstruction of a large knee defect following oncological resection - case report..Chirurgia (Bucur)2016;111:353-7

[17]

Nahabedian MY,Orlando JC,Hungerford DS.Operative management and outcome of complex wounds following total knee arthroplasty..Plast Reconstr Surg1999;104:1688-97

[18]

Vaienti L,Palitta G,Parodi PC.Limb trauma: the use of an advanced wound care device in the treatment of full-thickness wounds..Strateg Trauma Limb Reconstr2013;8:111-5 PMCID:PMC3732675

[19]

Cadenelli P,Radaelli S.Proximally based anterolateral-thigh (ALT) flap for knee reconstruction: an advancement propeller perforator flap..Aesthetic Plast Surg2015;39:752-6

[20]

Baxter BT,Johnson PJ,Pipinos II,Neff JR.Concomitant arterial and venous reconstruction with resection of lower extremity sarcomas..Ann Vasc Surg2007;21:272-9

[21]

Miyamoto S,Nakatani F,Sakuraba M.Free flow-through anterolateral thigh flap for complex knee defect including the popliteal artery..Microsurgery2015;35:458-88

[22]

Lee HY,Mehrara BJ,Alektiar KM,Disa JJ.Reconstruction after soft tissue sarcoma resection in the setting of brachytherapy: a 10-year experience..Ann Plast Surg2004;52:486-91

[23]

Choudry U,Karacor Z.Soft-tissue coverage and outcome of gustilo grade IIIB midshaft tibia fractures: a 15-year experience..Plast Reconstr Surg2008;122:479-85

[24]

Saito A,Imai T.Reconstruction following resection of soft-tissue sarcomas at the ankle region in seven patients..J Plast Reconstr Aesthetic Surg2010;63:1712-6

[25]

Zweifel-Schlatter M,Schaefer DJ,Ochsner P.Free fasciocutaneous flaps in the treatment of chronic osteomyelitis of the tibia: a retrospective study..J Reconstr Microsurg2006;22:41-7

[26]

Hong JP,Kim JJ,Chung YK.The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity..Plast Reconstr Surg2005;115:142-7

[27]

Weichman K,Thanik V,Mehrar BJ.Adipofascial anterolateral thigh free flaps for oncologic hand and foot reconstruction..J Reconstr Microsurg2015;31:684-7 PMCID:PMC4848039

[28]

Agostini T.Adipofascial anterolateral thigh free flap for hemifacial atrophy..Acta Otorhinolaryngol Ital2009;29:103-7 PMCID:PMC2808680

[29]

Cribb GL,Dickinson I.Limb salvage for soft-tissue sarcomas of the foot and ankle..J Bone Joint Surg Br2010;92:424-9

[30]

Brenner P.Abdominal wall and foot reconstruction after extensive desmoid tumor resection with free tissue transfer..Langenbeck's Arch Surg2002;386:592-7

[31]

Medina MA,Eberlin KR,Kwon JY,Cetrulo CLJr.Modified free radial forearm fascia flap reconstruction of lower extremity and foot wounds: optimal contour and minimal donor-site morbidity..J Reconstr Microsurg2014;30:515-22

[32]

Struckmann V,Struckmann F,Lehnhardt M,Daigeler A.Free and pedicled flaps for reconstruction of the weightbearing sole of the foot: a comparative analysis of functional results..J Foot Ankle Surg2014;53:727-34

[33]

Zaretski A,Meller I,Kollender Y,Bickels J,Ad-El D.Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options..Plast Reconstr Surg2004;113:1989-2000

[34]

Capanna R,Campanacci M.A new technique for reconstruction of large metadiaphyseal bone defects: a combined graft (allograft shell plus vascularized fibula)..Orthop Traumatol1993;2:159-77

[35]

Beris AE,Korompilias AV,Mitsionis GI,Soucacos PN.Vascularized fibula transfer for lower limb reconstruction..Microsurgery2011;31:205-11

[36]

Yajima H.Twin-barrelled vascularized fibular grafting to the pelvis and lower extremity..Clin Orthop Relat Res1994;178-84

[37]

Duffy GP,Rock MG,Sim FH.Vascularized free fibular transfer combined with autografting for the management of fracture nonunions associated with radiation therapy..J Bone Jt Surg - Ser A2000;82:544-54

[38]

Ruch DS.The fibula-flexor hallucis longus osteomuscular flap..J Bone Jt Surgery-British Vol1997;79:964-8

[39]

Mastorakos DP,Athanasian E,Healey JH.Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction..Plast Reconstr Surg2002;109:1567-73

[40]

Enneking WF,Gebhardt M,Pritchard DJ.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system..Clin Orthop1993;241-6

[41]

Doi K,Kawai S.Limb-sparing surgery in synovial sarcoma of the forearm and lower leg by reinnervated free muscle transfer..Plast Reconstr Surg1998;102:442-7

[42]

Doi K,Kawakami F,Otsuka K.Limb-sparing surgery with reinnervated free-muscle transfer following radical excision of soft-tissue sarcoma in the extremity..Plast Reconstr Surg1999;104:1679-87

[43]

Tsukushi S,Sugiura H,Ishiguro N.Results of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma in the lower extremity: Comparison between only arterial and arterovenous reconstruction..J Surg Oncol2008;97:216-20

[44]

Nishinari K,Aguiar Junior S,Yazbek G,Teivelis MP.Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities..J Vasc Surg2015;62:143-9

[45]

Wortmann M,Böckler D,Hyhlik-Dürr A.Vascular reconstruction after retroperitoneal and lower extremity sarcoma resection..Eur J Surg Oncol2017;43:407-15

[46]

Rosenthal HG,Lane JM.Management of extremity soft tissue sarcomas..Clin Orthop Relat Res1993;66-72

[47]

O'Sullivan B,Turcotte R,Wunder J,Kandel R,Tu D.Five-year results of a randomized phase III trial of pre-operative vs post-operative radiotherapy in extremity soft tissue sarcoma..J Clin Oncol2004;22:151-2

[48]

Baldini EH,Wang Q,Orgill DP,Marcus KJ,Devlin PM,Abraham J,Ready JE.Predictors for major wound complications following preoperative radiotherapy and surgery for soft-tissue sarcoma of the extremities and trunk: importance of tumor proximity to skin surface..Ann Surg Oncol2013;20:1494-9

[49]

Arbeit JM,Brennan MF.Wound complications in the multimodality treatment of extremity and superficial truncal sarcomas..J Clin Oncol1987;5:480-8

[50]

Shiu MH,Nori D,Hilaris B.Control of locally advanced extremity soft tissue sarcomas by function-saving resection and brachytherapy..Cancer1984;53:1385-92

[51]

O'Sullivan B,Turcotte R,Catton C,Wunder J,Goddard K,Pater J.Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial..Lancet2002;359:2235-41

[52]

Cheng EY,Winters MR.Soft tissue sarcomas: Preoperative versus postoperative radiotherapy..J Surg Oncol1996;61:90-9

[53]

Kunisada T,Powell G.Wound complications following pre-operative radiotherapy for soft tissue sarcoma..Eur J Surg Oncol2002;28:75-9

[54]

Davis AM,Turcotte R,Catton C,Wunder J,Benk V,Goddard K,Sadura A,Day A,Pater J.Canadian Sarcoma Group; NCI Canada Clinical Trial Group Randomized Trial. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma.Radiother Oncol2005;75:48-53

[55]

Townley WA,O'Neill AC,Ferguson PC,Hofer SO.Reconstruction of sarcoma defects following pre-operative radiation: Free tissue transfer is safe and reliable..J Plast Reconstr Aesthetic Surg2013;66:1575-9

[56]

Chao AH,Shuaib SW.The effect of neoadjuvant versus adjuvant irradiation on microvascular free flap reconstruction in sarcoma patients..Plast Reconstr Surg2012;129:675-82

[57]

Hidalgo DA.The treatment of lower extremity sarcomas with wide excision, radiotherapy, and free-flap reconstruction..Plast Reconstr Surg1992;89:96-101

[58]

Brennan MF,Shiu MH,Magill G,Hajdu SI.Local recurrence in adult soft-tissue sarcoma. A randomized trial of brachytherapy..Arch Surg1987;122:1289-93

[59]

Ormsby MV,Nori D.Wound complications of adjuvant radiation therapy in patients with soft-tissue sarcomas..Ann Surg1989;210:93-9 PMCID:PMC1357771

[60]

Hidalgo DA.The treatment of lower extremity sarcomas with wide excision, radiotherapy, and free-flap reconstruction..Plast Reconstr Surg1992;89:96-101; discussion 102

[61]

Spierer MM,Zelefsky MJ,Cordiero PG.Tolerance of tissue transfers to adjuvant radiation therapy in primary soft tissue sarcoma of the extremity..Int J Radiat Oncol2003;56:1112-6

[62]

Sadrian R,Friedman J,Steinau HU,Chang D,Evans GR.Intraarterial chemotherapy: the effects on free-tissue transfer..Plast Reconstr Surg2002;109:1254-8

[63]

Pisters PW,Woodruff J,Brennan MF.Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities..J Clin Oncol1996;14:1679-89

[64]

Popov P,Asko-Seljaavaara S,Virolainen M,Blomqvist C.Soft tissue sarcomas of the lower extremity: surgical treatment and outcome..Eur J Surg Oncol2000;26:679-85

[65]

Penna V,Momeni A,Bannasch H.Free tissue transfer in reconstruction following soft tissue sarcoma resection..Microsurgery2011;31:434-40

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