Oncologic safety of propeller flap and free flap in reconstruction after soft tissue sarcoma resection

Abstract

Background and ObjectivesThe propeller flap is a reliable option for reconstruction after soft tissue sarcoma resection. However, some parts of the resection margin may move away from its original position during flap rotation and thus can be excluded from the clinical target volume of adjuvant radiotherapy. This study aimed to evaluate local recurrence after soft tissue sarcoma resection with propeller flap or free flap reconstruction.MethodsPatients who underwent resection of soft tissue sarcoma followed by a free flap or propeller flap reconstruction and adjuvant radiotherapy at a single institution were retrospectively reviewed.ResultsThe 1‐ and 3‐year local control rates were 94.6% and 88.6% in the free flap group vs 90.6% and 87.5% in the propeller flap group, without statistical significance. There were no statistically significant differences in 5‐year local recurrence‐free survival (88.6% vs 87.5%) and disease‐free survival (82.5% vs 74.8%) between the groups.ConclusionsAlthough there was no significant difference in local control and disease‐free survival rates between propeller flap and free flap reconstruction after soft tissue sarcoma resection, a multidisciplinary approach is needed to obtain surgical information for determining the accurate clinical target volume of adjuvant radiotherapy and the area for meticulous follow‐up postoperatively.

How to Start and Build Microsurgery Practice—Topics on Success and Sustainability: Global/International

“… 25 Therefore, the level of treatment in other departments must also improve. 26 Periodic weekly or monthly meetings are a great help in building teamwork. When each department shares various opinions about a patient, not only does the level of treatment improve, but also mutual trust builds up.…”

Risk of translocated soft-tissue sarcoma recurrence using perforator propeller flap: Case report and literature review

“…The insetting of the propeller flap could have rotated 180° of the distal excision margin where the disease eventually recurred. As suggested by Cha et al, 31 a multidisciplinary approach in planning oncologic resection and method of reconstruction to inform the radiation oncologist for an increase in target volume radiotherapy after propeller flap reconstruction to include proximal margin of the flap that was the nearest to sarcoma side.…”

Practical Strategies in Reconstruction of Soft-Tissue Sarcoma

“…7). [39][40][41] In the setting of more extensive defects, a free tissue transfer likely represents the best option (Fig. 8).…”

“…Soft-tissue sarcomas have a high predilection for the lower extremity, which is the most common site for sarcomas. 39 As with all patients, the workup should be specific for the anticipated defect, with evaluation of the surrounding tissue for local options or primary closure. However, again, because radiation therapy is often an integral component of multimodality treatment, primary closure and local pedicle flaps may not be reliable.…”

“…[45][46][47] In the setting in which primary closure cannot be performed, local options such as pedicle flaps or propeller flaps are reliable means for reconstruction and have demonstrated acceptable outcomes. 39,46 The use of keystone flaps, propeller flaps, or local pedicle perforator flaps in the torso and extremity has been well-described and can be used just as reliably for sarcoma reconstruction. 46,47 However, in the setting when the resection is more extensive (>100 cm 2 in the upper extremity), especially to obtain clear margins, a free tissue transfer is often necessary, with numerous studies confirming high success rates despite prior radiation therapy.…”