Functional Muscle Transfer after Oncologic Extremity Resection

Abstract

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.

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

“…Forearm, rectus abdominis, and anterolateral thigh (ALT) flaps for use on soft tissues and fibula only, deep circumflex iliac artery, and scapula flaps that include bone are available, wherein each flap is observed to have its own advantages and disadvantages. 16 The most important factor in flap surgery is the main pedicle of the flap; thus, an accurate knowledge of vascular anatomy is very important and fundamental in flap surgery. 17 The LD flap is a fan-shaped flap that offers the advantages of providing a muscle rich in blood supply, providing a bulky flap no matter the defect, and causing little problem in the activities of daily living due to few donor site complications.…”

“…Forearm, rectus abdominis, and anterolateral thigh (ALT) flaps for use on soft tissues and fibula only, deep circumflex iliac artery, and scapula flaps that include bone are available, wherein each flap is observed to have its own advantages and disadvantages. 16 The most important factor in flap surgery is the main pedicle of the flap; thus, an accurate knowledge of vascular anatomy is very important and fundamental in flap surgery. 17…”

The evolution of pediatric soft‐tissue free flap reconstruction of the lower extremity after oncologic resection: A 30 year experience

“…Even a small wound healing problem will delay chemotherapy or radiation, which has a negative prognostic effect on cancer treatment. Additionally, data shows that free flaps have improved healing abilities compared to pedicled flaps, so they might be preferred in a pediatric population in an attempt preserve limb mobility and encourage normal growth and development (Cannon et al, 2006; Gabrysz‐Forget et al, 2019; Hassan et al, 2022; Kane et al, 1999; Van Landuyt et al, 2005; Wang et al, 2019). Pediatric patients often have shorter flap pedicles, potentially complicating the process of locoregional flap transfer (Aboelatta & Aly, 2013; Chiang et al, 1997; Van Landuyt et al, 2005).…”

“…The overall rate of complications in our cohort was high at 43%, the majority of which was related to wound healing issues. Most of these patients received neoadjuvant or adjuvant chemotherapy or radiation, a factor which may have potentiated this problem (Cannon et al, 2006; Hassan et al, 2022). Flap success rate was 95%, which is in concordance with rates in the adult population (López et al, 2015; Shimbo et al, 2022).…”