Hypothesis: Upper extremity limb salvage following sarcoma extirpation can be safely and reliably performed using microvascular flaps.

Methods: A retrospective analysis was performed on all patients at our institution (1992-2002) who underwent microvascular reconstruction following sarcoma extirpation.

Results: A total of 17 patients met the inclusion criteria. Mean follow-up was 38 months. Average age of the patients was 52 years old. The male:female distribution was 59%:41%. Location of the primary tumor was distal to the elbow in 59% of patients (n=10). Average defect size was 160 cm2. Most cases (71%, n=12) were recurrent sarcomas at time of evaluation. Malignant fibrous histiocytoma variants were the most common pathologic subtype (n=6); followed by leiomyosarcoma (n=3); osteosarcoma (n=2); liposarcoma (n=2); and synovial cell sarcoma (n=2). High-grade tumors comprised 71% (n=12) of the lesions. Most patients (59%, n=10) received pre-operative chemotherapy; 76% (n=13) patients received pre-operative radiation therapy and 12% (n=2) received post-operative radiation therapy.

Free flap survival was 100%. Two patients were taken back to the OR for venous congestion and the flaps survived without sequelae following anastomotic revision. There was no flap infection nor dehiscence and one donor site hematoma. The rectus abdominis was the most common free flap used (41%; n=7), followed by the latissimus dorsi free flap (18%, n=3). Four patients (24%) had local recurrence with three ultimately requiring amputations (with subsequent disease-free survival). One of the patients with local recurrence died of concomitant metastatic disease. The average modified Enneking score for limb function was 68% (n=14). Cumulative 5-year disease-specific survival was 50%. Overall actuarial survival was 3.2 years.

Conclusion: In select patients undergoing upper extremity limb salvage for advanced sarcoma, microvascular flap reconstruction can provide reliable, safe coverage with maintenance of a functional upper extremity.