Fibrohistiocytic sarcoma of the thumb treated by wide resection and immediate free flap reconstruction. Case report.

A 29 year old surgical resident presented with a fibrohistiocytic sarcoma over the thumb of his dominant right hand. The tumour was widely excised including the ulnar neurovascular bundle. The resultant defect was immediately reconstructed with a sensory forearm free flap from the opposite upper extremity. The patient was then given a curative dose of cobalt-60 radiotherapy starting in the fourth postoperative week. With a comprehensive regimen of physiotherapy and splinting, the patient regained an almost full range of movement in his right thumb and was able to resume his regular duties in the operating theatre two months after his operation. Soft tissue sarcomas of the hand are a real therapeutic challenge. Adequate control of the tumour in most instances requires amputation because limb sparing procedures require soft tissue coverage not available locally or achieved easily. In addition, preservation of a hand, or parts of it, with poor functional capacity, is not helpful.