Practical Strategies in Reconstruction of Soft-Tissue Sarcoma

Abstract

Learning Objectives: After studying this article, the participant should be able to: 1. Discuss the natural history and pathophysiology of sarcoma. 2. Summarize the most up-to-date multidisciplinary management of soft-tissue sarcoma. 3. Provide a synopsis of reconstructive modalities based on anatomical location. 4. Highlight some novel strategies for treatment of lymphedema and phantom limb pain that are common sequelae following treatment and resection of soft-tissue sarcomas. Summary: The management of soft-tissue sarcoma presents unique challenges to the reconstructive surgeon. The optimal management mandates a multidisciplinary approach; however, reconstruction must take into account the extent of the resection and exposed vital structures, but often occurs in the setting of adjuvant treatments including chemotherapy and radiation therapy. Reconstruction is based on the extent of the defect and the location of the primary tumor. As such, an evidence-based, algorithmic approach following the reconstructive ladder is warranted to minimize the risks of complications and maximize success, which varies from head and neck to torso to breast to extremity sarcomas. Aside from reconstruction of the defect, advances in the surgical treatment of lymphedema and neuropathic pain resulting from treatment and extirpation of soft-tissue sarcoma are critical to maintain function and patients’ quality of life.

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas

“…Furthermore, a review and series of cases explored the approach to lower extremity reconstruction after STS resection, including key concepts of multidisciplinary care and planning 36 . A recent article published by Plastic and Reconstructive Surgery 37 discussed common complications after wide excision, including the importance of following techniques described by the reconstruction ladder 38 . While the children's oncology group INSTRuCT has started to define some consensus, 39 future questions still lie in delineating an optimal, morbidity‐minimizing strategy for reconstructive surgery techniques.…”

Three-dimensional Planning for Lower Extremity Soft-tissue Reconstruction after Sarcoma Resection: Systematic Review and Reflections

“…Soft-tissue sarcomas are a rare and surgically-challenging solid tumor most commonly found in the lower extremity. 1 As recently described in this journal, reconstructive planning for soft-tissue sarcomas follows the reconstructive ladder, aiming to replace “like-with-like” by incorporating primary closure, grafts, and vascularized local or free flaps as required to facilitate wound healing.…”

Practical Strategies in Reconstruction of Soft-Tissue Sarcoma: Additional information

“…With great interest, we read the November 2022 CME article by Aten and Chang entitled “Practical Strategies in Reconstruction of Soft-Tissue Sarcoma.” 1 The authors shared a relevant overview of practical strategies for reconstructing soft-tissue sarcoma. We would like to share our experience in soft-tissue sarcoma management and highlight current points of their management.…”