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This paper aims to provide evidence-based guidance for the general orthopaedic surgeon faced with the presentation of a potential soft tissue sarcoma in an extremity.

An analysis was conducted of all patients undergoing flap surgery for the treatment of head and neck cancers between September 2015 and August 2016. 57 patients underwent flap surgery, 72% for SCC, 21.0% for sarcoma and 7% for other. Of these, 9/57 had previous head and neck cancer. The median time from first surgical clinic until surgery was 41 days while the median time from first multidisciplinary team (MDT) meeting to surgery was 27 days.Of the flap cases: 19/57 were radial forearm, 17/57 fibula, seven pectoralis major, three latissimus dorsi, two anterolateral thigh, two facial artery musculomucosal and five other. 66.7% of patients underwent a surgical tracheostomy and 78.9% had at least one dental extraction. The median inpatient stay was 14 days and the median intensive care unit stay was two days. 26.3% had no complications while 31.6% had grade 1, 17.6% a grade 2, 10.5% a grade 3a, 7% grade 3b and 7% grade 4a. 1 There were a total of eight returns to theatre, with a total of three flap failures (5.3%), two flap salvages (3.5%) and three other causes. The final histology diagnosis correlated with the initial MDT diagnosis 93.8% of the time. Initial MDT TNM staging correlated with final TNM staging with 67.6% of patients. Margins were 5 mm or greater in 62.5% of patients.