Advances in functional limb reconstruction in the irradiated setting

Marsden, Nicholas; Grinsell, Damien

doi:10.20517/2347-9264.2019.14

Cited by 2 publications

(3 citation statements)

References 33 publications

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“…However, studies in STS specifically showed that the majority of patients are likely to recover at least protective sensation of the foot and this is why some advocate its reconstruction even though motor function is rarely restored. [30][31][32] Although this study included too few cases to make proper assumptions, the reconstruction of nerves may also reduce neuropathic pain. 33…”

Section: Use Of Functional Reconstructions In Mpnstsmentioning

confidence: 99%

Morbidity and Function Loss After Resection of Malignant Peripheral Nerve Sheath Tumors

et al. 2021

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BACKGROUND Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas. Their resection may lead to serious morbidity. Incidence of postoperative motor and sensory deficits is unknown, and reconstruction aimed at restoring such deficits is infrequently carried out. OBJECTIVE To identify the incidence and risk factors of postoperative morbidity in MPNST as well as the use and outcomes of functional reconstructions in these patients. METHODS Postoperative function and treatment of MPNSTs diagnosed from 1988 to 2019 in 10 cancer centers was obtained. Two models were constructed evaluating factors independently associated with postoperative motor (<M3) or critical sensory loss. Critical sensation was defined as partial or complete loss of hand, foot, or buttocks sensation. RESULTS A total of 756 patients (33.4% neurofibromatosis type 1, NF1) were included. MPNSTs originated in 34.4% from a major nerve. Of 658 surgically treated patients, 27.2% had <M3 muscle power and 24.3% critical sensory loss. Amputations were carried out in 61 patients. Independent risk factors for motor and sensory loss included patients with NF1, symptomatic, deep-seated, extremity, or plexus tumors originating from major nerves (all P < .05). A total of 26 patients underwent functional reconstructions. The majority (64%) of these patients regained at least M3 muscle power and 33% M4 despite 86% receiving multimodal therapy. CONCLUSION Resection of MPNSTs commonly results in motor and sensory deficits. Patients with NF1, symptomatic, deep-seated tumors, arising from major nerves were associated with a higher risk for developing postoperative morbidity. Functional reconstructions are infrequently performed but can improve functional outcomes.

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Section: Use Of Functional Reconstructions In Mpnstsmentioning

confidence: 99%

Morbidity and Function Loss After Resection of Malignant Peripheral Nerve Sheath Tumors

et al. 2021

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“…Aside from restoring motor function to the involved extremity, FMT with vascularized, nonirradiated tissue provides several other reconstructive advantages over local options, all of which potentiate more reliable wound healing: improved soft tissue resurfacing, ample tissue volume for filling dead space, and durable coverage or critical neurovascular structures and/or bone. [16][17][18] Studies evaluating outcomes following FMT are heterogeneous, involving various techniques and metrics. To assess the feasibility, outcomes, and predictors of success or failure of FMT, a review of the literature is needed.…”

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Functional Muscle Transfer after Oncologic Extremity Resection

Hassan

Tesfaye

Rashiwala

et al. 2022

J Reconstr Microsurg

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Background: Functional muscle transfer (FMT) can provide wound closure and restore adequate muscle function for patients with oncologic extremity defects. Herein we describe our institutional experience with FMT after oncological resection and provide a systematic review and meta-analysis of the available literature on this uncommon procedure. Methods: A single-institution retrospective review was performed, including all patients who received FMT after oncological resection from 2005-2021. For the systematic review and meta-analysis, PubMed, Cochrane, Medline, and Embase libraries were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; results were pooled, weighted by study size, and analyzed. Results: The meta-analysis consisted of seven studies with 70 patients overall, demonstrating a mean MRC score of 3.78 (95% CI, 2.97-4.56; p < 0.01). The systematic review included 28 studies with 103 patients. Receipt of adjuvant chemotherapy was associated with significantly lower mean MRC score (3.00 ± 1.35 vs. 3.90 ± 1.36; p = 0.019). Seventy-four percent of the patients underwent free FMT, with the most common donor muscle being the latissimus dorsi (55%). The flap loss rate was 0.8%. Neoadjuvant chemotherapy (p = 0.03), radiotherapy (p = 0.05), pedicled FMTs (p = 0.01), and a recipient femoral nerve (p = 0.02) were associated with significantly higher complication rates. The institutional retrospective review identified 13 patients who underwent FMT after oncological resection with a median follow-up time of 21 months (range, 6-74 months). The most common tumor necessitating FMT was undifferentiated pleomorphic sarcoma (77%), and the most common donor muscle was the latissimus dorsi (62%). A high body mass index was associated with prolonged neuromuscular recovery (R = 0.87, p = 0.002). Conclusion: FMT after oncological resection may contribute to improved extremity function. Careful consideration of risk factors and preoperative planning is imperative for successful FMT outcomes.

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Advances in functional limb reconstruction in the irradiated setting

Cited by 2 publications

References 33 publications

Morbidity and Function Loss After Resection of Malignant Peripheral Nerve Sheath Tumors

Morbidity and Function Loss After Resection of Malignant Peripheral Nerve Sheath Tumors

Functional Muscle Transfer after Oncologic Extremity Resection

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