The 2003 Annual Meeting of OASYS_NEW

Not yet assigned to a slot - 2:00 AM

Soft Tissue Coverage of Alloplastic Prostheses Used during Limb Salvage Surgery for Sarcomas

Deune EG1, Tufaro AP1, Lietman S2, Frassica D3, and Frassica F2. (1) Division of Plastic Surgery, Johns Hopkins School of Medicine, 601 N. Caroline St, JHOC 8152B, Baltimore, MD, USA, (2) Dept of Orthopedics, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA, (3) Dept of Radiation Oncology, Johns Hopkins School of Medicine, 10753 Falls Rd, Suite 145, Baltimore, MD, USA

Limb salvage surgery for sarcomas requires wide surgical resection. When joint resection is required, we routinely reconstruct with alloplastic joints to maintain limb function. Reliable soft tissue coverage of these joints is crucial, as implant infection and exposure may result in amputation and failure of the limb salvage surgery.

Between February 1998 and May 2002 (51 months), 74 patients underwent limb-sparing surgery for sarcomas with immediate soft tissue flap coverage. Of those, 8 patients (M=5, F=3, mean age: 48.1±18.5 yrs, range 26-71) required joint resection and insertion of alloplastic joints (shoulder, n=3; knee n=5) with immediate flap coverage. The tumors were located in the proximal humerus (n=3), distal femur (n=1), and proximal tibia (n=4). Malignant fibrous histiocytoma was the most common (n=4) followed by osteosarcomas (n=2). 7 of the 8 tumors were high grade. There were 13 flaps (2 free, 11 pedicle). The most common were the gastrocnemius (n=4), latissimus dorsi (n=3), and rectus abdominis (n=2). One free flap died from venous thrombosis requiring a second rectus abdominis free flap. All pedicle flaps survived. Overall flap survival at 92.3%. 7 had adjuvant therapy (4 preoperatively, 3 postoperatively).

Mean follow-up has been 14.2±10.9 months. 63% (n=5) of the patients had one or more postoperative complications: flap loss (n=1), delayed healing (n=3), latissimus donor site seroma (n=1), periprosthetic infection (n=1) Two patients (flap loss, periprosthetic infection) required repeat surgeries to successfully treat their complications. There has been no local recurrence and no amputations. 2 patients have developed metastasis (lung: 1; spine: 1), but all patients remain alive. All these patients were referred to physical therapy as soon as their wounds had sufficiently healed.

Postoperative function was graded as excellent, good, or poor. 38% (n=3) patients had excellent function, reporting preoperative function. 50% (n=4) had moderate function with some restrictions, and 13% (n=1) had poor function. Functional recovery was better for the lower extremity than for the upper. All 5 (100%) patients with knee replacements while only 2 (66%) patients with shoulder replacements reported excellent or good function.

Sarcoma involvement of joints should not be a contraindication to limb-sparing surgery. Joint resection and concurrent insertion of alloplastic implants with immediate flap coverage can successfully rehabilitate limbs that otherwise would have been amputated. Despite a high complications rate, all limbs have been salvaged and overall success has been high with excellent to good limb function.


Back to Session E-1 Extremity and Trunk
Back to American Society for Reconstructive Microsurgery

Back to The 2003 Annual Meeting