The 2003 Annual Meeting of OASYS_NEW

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No Tumor Recurrence at Donor Site When Local Flaps Are Used for Immediate Coverage in Limb Salvage Surgery for Sarcomas

Deune EG1, Nahabedian M2, Tufaro AP1, Frassica D3, Lietman S4, and Frassica FJ5. (1) Division of Plastic Surgery, Johns Hopkins School of Medicine, 601 N. Caroline St, JHOC 8152B, Baltimore, MD, USA, (2) Division of Plastic Surgery, Johns Hopkins University, 601 North Caroline Street, 8152C, Baltimore, MD, USA, (3) Dept Radiation Oncology, Johns Hopkins School of Medicine, 10753 Falls Rd, Suite 145, Baltimore, MD, USA, (4) Dept of Orthopedics, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA, (5) Dept of Orthopedic Surgery, Johns Hopkins School of Medicine, 601 N. Caroline St, Baltimore, MD, USA

Wide tumor resection, sparing major nerves and vessels with immediate soft tissue coverage and adjuvant therapy has become the treatment modality for limb sarcomas. Choices of soft tissue coverage include local, regional, or distant free flaps. Although easier, the use of local or regional flaps raises concerns about potentially seeding tumor into the flap donor bed. Meticulous handling of the tumor during dissection to prevent spillage and changing all drapes, instruments, gowns, and gloves prior to the resection are important protocols to follow.

74 patients with limb sarcomas underwent limb salvage and immediate soft tissue reconstruction between February 1998 and May 2002 (51 months). Of these, we analyzed those patients who were reconstructed with local flaps and who had at least 12 months of follow-up (mean: 19.1±6.2 months, range 12-31). 21 patients were identified (M=12, F=9) with a mean age of 54.0±18.2 yrs (range: 20-79yrs). The most common tumor was MFH (n=9, 43%), followed by osteogenic sarcoma (n=2) and liposarcoma (n=2). 71% of the tumors were high-grade (n=15). The thigh (n=5, 24%) and the upper arm (n=5, 24%) were the most common locations followed by the lower leg (n=3, 14%). Three patients had alloplastic joint replacement and two had allograft bone replacement. 23 pedicle flaps were used to cover 21 wounds. One wound required 3 flaps. The latissimus dorsi (n=6) and the rectus abdominis (n=5) were used most often. All flaps survived. Complications were minor: delayed wound healing or seroma of the recipient sites. 8 patients had preoperative adjuvant therapy. 12 had postoperative therapy, including 5 who had brachytherapy.

Two patients developed local recurrences in the original tumor bed (gluteal and upper arm) but both donor flap sites (vastus lateralis, latissimus) remained tumor-free. There has been to date, no tumor recurrence in the donor sites of flaps used to cover the wounds in these 21 patients. 6 patients have developed metastasis and two have died (mean survival time: 17.0±4.2 months). The most common location was the lung (n=3, 37%).

Limbs functions were self-rated. 15 (71%) reported excellent motion with no or little restrictions when compared to preoperative levels and 6(29%) reported moderate function with some limitations. No limbs have been amputated.

Successful flap coverage of complex wounds in limb sparing surgery for sarcomas is vital for success. The concern for seeding tumor into the flap bed remains real. Based on our experience, this concern can be lessened.


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