Free Functional Latissimus Dorsi Reconstruction of the Quadriceps and Hamstrings following Oncologic Resection of Soft Tissue Sarcomas of the Thigh

Abstract

Background. Limb-salvage surgery combined with radiotherapy has become the primary treatment for soft tissue sarcomas of the extremity. Free functional latissimus flaps (FFLF) are an option to restore function in the setting of volumetric muscle loss. The purpose of the current study was to examine the use of FFLF in patients undergoing resection of thigh sarcoma. Methods. Twelve patients with a sarcoma involving the hamstring (n = 6), quadriceps (n = 5), or combined (n = 1) defects which included multiple muscle groups were reviewed. This included 9 males and 3 females with a mean age and body mass index of 56 ± 12 years and 31.3 ± 5.7 kg/m2. Results. The mean defect volume and operative time was 3,689 ± 2,314 cm3 and 587 ± 73 minutes. Following reconstruction, the mean knee range of motion (ROM), MSTS93 score, and muscle strength was 89 ± 24°, 90 ± 15%, and 4 ± 1; with 75% of patients ambulating without gait aids. Seven (58%) patients sustained a complication, namely, delayed wound healing (n = 2). Conclusion. Although there was a high incidence of complications, FFLF can restore active knee ROM and function, with most patients ambulating without gait aids following reconstruction of large oncologic defects in the thigh.

Pedicled Functional Latissimus Flaps for Reconstruction of the Upper Extremity following Resection of Soft-Tissue Sarcomas

“…The multidisciplinary oncologic team is critical to the successful management of patients with soft tissue sarcoma [ 15 , 22 , 23 ]. At our institution, the orthopedic oncology team works in conjunction with plastic surgery, radiology, pathology, radiation oncology, medical oncology, and physical therapy to ensure patients are given the best chance at disease-free survival and to optimize functional outcomes.…”

“…The latissimus, works synergistically with other muscles of the shoulder and arm to execute shoulder adduction, extension, and internal rotation [ 15 , 25 , 26 , 27 ]. The extent of functional impairment following harvesting the flap is debated, and patients should be cautioned on the potential for a clinically important decrease in shoulder strength and discomfort, which could limit activities of daily living.…”

“…Free functional latissimus flaps have been utilized to restore function of the hamstrings, quadriceps, and gastrocnemius muscles in the lower extremity [ 11 , 12 , 13 , 14 ] and have been shown to restore active knee function after lower extremity STS resection [ 15 ]. The use of latissimus flaps has also been described for functional reconstruction in the upper extremity in the setting of trauma and brachial plexus injury [ 7 , 16 ], but has not been largely analyzed with regard to function and complications in the setting of STS resection.…”

Thigh reconstruction between form and function: An algorithm for flap selection based on a series of 70 oncological patients

“…Rectus abdominis (RA), RF, VL and LD were reported to allow restoration of knee extension after oncological surgery (Grinsell et al, 2019; Innocenti et al, 2009; Lo et al, 2012; Muramatsu et al, 2011). However, most authors observed how LD could not compensate for the lost function entirely, achieving satisfactory functional outcomes only when at least one of the quadriceps muscles had been spared (Houdek et al, 2021; Innocenti et al, 2009; Muramatsu et al, 2011). Better functional outcomes after total quadriceps loss were reported for RA and gracilis muscle transfers (Grinsell et al, 2019; Nguyen et al, 2019).…”

Modeling of active skeletal muscles: a 3D continuum approach incorporating multiple muscle interactions

“…In this study, we extended the 3D active muscle model presented above into a body system level with multiple lower extremity muscles ( Figure 4A ), aiming to examine the effectiveness and stability of simulating motion with multiple instances of the above presented pipeline for single active muscle modeling. Simulation of the quadriceps mechanism including the knee is important for the investigation of muscle pathologies and treatments that impact lower limb function, such as acute injury ( Puladi et al, 2022 ), fibrosis ( Hung et al, 2014 ), and sarcoma ( Houdek et al, 2021 ). To simulate active quadriceps, we have a baseline model of the right lower limb which included subject-specific bony structures and cartilages of the knee segmented from computed tomography (CT) and magnetic resonance imaging (MRI) ( Hume et al, 2019 ).…”