Between February 1998 and May 2002 (51 mo), 74 patients (M=52 F=22, mean age: 50.8±17.1 yrs) underwent salvage of 75 limbs (54 lower extremity, 21 upper extremity) at our medical institution by a multidisciplinary team of orthopedic oncologist, radiation oncology, and reconstructive surgeons. 69% of the tumors were high-grade (n=51). 41% of the tumors was MFH (n=30), and the thigh was the most common location (n=30). 75% of the coverage was done by the rectus abdominis (n=28), latissimus dorsi (n=19), and the gastrocnemius (n=13). 33 (45%) patients had additional reconstructive surgeries; the most common being tendon transfers/grafting and allograft bone or alloplast joint placement.

Follow-up has been 13.1±10.1 mo (range: 1–43 mo) with 4 lost to follow-up. Surgery took 8.2±2.9 hrs and patients stayed 7.8±3.8 days. Of the 84 flaps, 33 were free with one acute loss (3%) and three late (9.1%). All pedicle flaps survived. (total flap survival: 95.1%) 63 patient had adjuvant therapy, 35 preoperatively and 45 postoperatively. 18 had brachytherapy radiation starting on 6.5±1.7 days with no flap loss.

39 (52%) patients had wound complications. Delayed wound healing (n=16) and wound seromas (n=15) were the most common. There were 10 non-wound related complications (18.4%) the most being nerve palsy (n=4). 20 patients (27.0%) require operative intervention with wound debridement (n=9) and seroma drainage (n=6). 3 have developed local recurrence. 5 had metastasis preoperatively with 12 developing metastasis postoperatively. The most common location being the lung. 5 patients have died with mean survival at 11.3±7.4 months after surgery. Perioperative mortality was zero.

Limb functionality was graded as excellent (return to preoperative level), moderate (some limitation in range or strength), or poor (minimal use due to pain or poor motion). 41 have regained full limb use. 24 have moderate use. 5 have limited use. Overall, 65 (94%) have full to moderate limb function. No limbs have been amputated.

This ongoing analysis of our experience with limb salvage for sarcomas continues to indicate favorable results in functional of limbs that historically would have been amputated. Although local wound complication rate was high, limb salvage should be performed whenever possible to avoid the morbidities associated with amputations.