Enrico Martin1, Max J Dullaart1, Michiel A J van de Sande2, Winan J van Houdt3, Pascal P A Schellekens1, J Henk Coert4. 1. Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands. 2. Department of Orthepedic Surgery, Leiden University Medical Center, the Netherlands; Department of Pediatric Orthopedic Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands. 3. Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands. 4. Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands. Electronic address: j.h.coert@umcutrecht.nl.
Abstract
BACKGROUND: Although resection of extremity soft tissue sarcomas can occasionally lead to large disabilities, literature regarding the necessity and outcome of functional reconstructions are scarce. The goal of this review is to assess outcomes and usage of functional reconstructions in light of multimodal treatment. METHODS: A systematic search was performed in July 2018 in PubMed and Embase databases according to the PRISMA guidelines. Search terms related to 'soft tissue sarcoma' and 'functional reconstruction' were used. Case series evaluating outcomes of functional reconstructions after STS resection were included. Functional reconstructions were limited to free functioning muscle transfers, tendon reconstructions, and nerve reconstructions. Qualitative synthesis was performed on all studies. Tumor grade, multimodal treatment, reconstruction, outcomes, and complications were collected from individual patient data. Results were summarized by tumor site. RESULTS: Fourteen studies were included after full-text screening. A total of 134 patients were described, of which the majority (74.9%) had functional reconstructions in the lower extremity. Radiotherapy and chemotherapy were administered in 60.3% and 49.4% respectively. Free functioning muscle transfers were used in 41.0% of all cases, tendon reconstructions in 58.2%, and nerve reconstructions in only 12.7%. A wide variety of outcome measures were used. Most patients regained good functionality, also after multimodal treatment. Unfavorable outcomes were often related to flap failure or allograft tendon rupture. CONCLUSION: Functional reconstructions in extremity STS are rarely described, but generally result in good functionality in spite of multimodal treatment. Early participation of reconstructive surgeons may help achieve ideal functional and oncological outcomes.
BACKGROUND: Although resection of extremity soft tissue sarcomas can occasionally lead to large disabilities, literature regarding the necessity and outcome of functional reconstructions are scarce. The goal of this review is to assess outcomes and usage of functional reconstructions in light of multimodal treatment. METHODS: A systematic search was performed in July 2018 in PubMed and Embase databases according to the PRISMA guidelines. Search terms related to 'soft tissue sarcoma' and 'functional reconstruction' were used. Case series evaluating outcomes of functional reconstructions after STS resection were included. Functional reconstructions were limited to free functioning muscle transfers, tendon reconstructions, and nerve reconstructions. Qualitative synthesis was performed on all studies. Tumor grade, multimodal treatment, reconstruction, outcomes, and complications were collected from individual patient data. Results were summarized by tumor site. RESULTS: Fourteen studies were included after full-text screening. A total of 134 patients were described, of which the majority (74.9%) had functional reconstructions in the lower extremity. Radiotherapy and chemotherapy were administered in 60.3% and 49.4% respectively. Free functioning muscle transfers were used in 41.0% of all cases, tendon reconstructions in 58.2%, and nerve reconstructions in only 12.7%. A wide variety of outcome measures were used. Most patients regained good functionality, also after multimodal treatment. Unfavorable outcomes were often related to flap failure or allograft tendon rupture. CONCLUSION: Functional reconstructions in extremity STS are rarely described, but generally result in good functionality in spite of multimodal treatment. Early participation of reconstructive surgeons may help achieve ideal functional and oncological outcomes.