Reconstruction of upper limb soft-tissue defects after sarcoma resection with free flaps: A systematic review

Abstract

Background and Objectives: Upper limb preservation after soft tissue sarcoma (STS) surgical excision is now the accepted gold standard and it often requires reconstruction with free flaps. The purpose of this review is to summarize current literature on upper limb reconstruction with free flaps after STS resection. Methods: A systematic review was performed in July 2019 in PubMed and MedLine Ovid databases according to the PRISMA guidelines. Results: A total of 17 studies were included in the final analysis, with 132 patients. The most common diagnosis was Malignant Fibrous Histiocytoma. The most frequent timing of flap coverage was immediate. The success rate was almost always 100%. The length of follow-up was reported in 11 studies with a range of 2-187 months. The most commonly reported patientcentered outcome was the MSTS Score. Based on the evidence of the literature collected, we divided the upper limb into four parts (shoulder, elbow and arm, forearm and wrist, and hand) and described the most common and functional free flaps used for reconstruction after STS resection. Conclusions: Free flaps in the treatment of STS of the upper extremity have a good overall outcome, with a low postoperative complication rate. A wide array of free flaps is available for reconstruction, and the choice of flap is based on defect size, types of tissue required, postoperative functional goal, and surgeon preference. A greater degree of standardization is needed in the reporting of patient-centered outcomes to facilitate future comparative studies.

Single-Stage Reconstruction with Innate Chimeric-Free Fibula Flap in Limb-Preserving Excision of Upper Limb Sarcomas

“…Extremity sarcomas are malignant mesenchymal tumors that were historically treated by extremity amputation, but the recent advances in microsurgical techniques, radiological imaging, and adjuvant therapy have made limb preservation possible in the majority of cases. 4 8 The ideal treatment for musculoskeletal tumor is WLE that provides adequate surgical clearance and sufficient locoregional control, which is the primary determinant for long tumor-free survival. 9 10 In the pursuit of obtaining locoregional control of the disease, more challenging complex composite defects were created by the oncosurgeons.…”

“…1 6 Resection of extremity sarcomas often results in significant complex composite defects that are not amenable for simple reconstruction. In these cases, pedicled or free flap reconstruction is necessary to provide long-term stable soft tissue cover 4 with a good chance for functional recovery. Microvascular reconstruction of the upper extremity sarcoma re-establishes the anatomical, structural continuity in a single stage and, with its inherent distant donor site, does not increase the morbidity of an already compromised upper limb.…”

“…Thus, innate chimeric-free fibula flap(it is nonfabricated, anatomically available multiple tissue component harvested on independent perforators arising from the same peroneal source vessel) has all prospects for functional and anatomical reconstruction of these complex composite postexcisional defects. 4 This study evaluates the effectiveness of our novel technique of single-stage reconstruction of the upper extremity, following sarcoma excision, where there was a complex composite defect using the innate chimeric-free fibula flap.…”

Functional Forearm Reconstruction With a Latissimus Dorsi Free Flap and Tendon Transfer After Congenital Soft-Tissue Sarcoma Resection in a 29-Week-Old Girl: A Case Report

“…Unfortunately, there is still a general unjustified reticence toward the use of microsurgical techniques in infants [5,13], for whom surgeons tend to prefer less risky but mutilating procedures to ensure radical resection margins. Functional muscle transfer for restoration of upper limb flexion/extension of fingers, wrist, or elbow can be obtained by transfer of an innervated LD or gracilis [3,9]. The use of several types of LD flap is well established for reconstruction and resurfacing of soft-tissue defects in the upper extremity, including for defects after tumor extirpation.…”

What are the Results of Resection of Forearm Soft Tissue Sarcoma?

“…In the case of skin defects, which cannot be covered by split thickness skin graft (STSG), local pedicled or perforating aps can be utilized 16,17 . However, they can increase the risk of cross-contamination.…”