SINGLE-STAGE, MULTIMODALITY TREATMENT OF SOFT-TISSUE SARCOMA OF THE EXTREMITY

The present study describes the techniques available for single-stage sarcoma resection, soft-tissue reconstruction, and radiotherapy for li mb preservation in patients who are unable to undergo primary wound cl osure after a complete soft-tissue resection of their primary sarcoma. From 1989 to 1994, 19 patients (age range, 18-79 years; mean, 51.2 ye ars) underwent radical resection of extremity sarcomas followed by imm ediate reconstruction. Seven patients had tumors in the upper extremit y and 12 patients had tumors in the lower extremity. There were 13 pri mary tumors and 6 recurrent tumors. Fifteen patients (79%) received ra diation therapy, 7 patients by external beam and 8 patients by brachyt herapy. Reconstruction included 16 regional flaps in 13 patients and 7 free tissue transfers in 6 patients. Commonly used flaps included the rectus abdominis (N = 5), the latissimus dorsi (N = 4), the anterolat eral thigh (N = 4), the reverse-flow radial forearm (N = 2), and the g astrocnemius (N = 2) flaps. Complications included wound breakdown (N = 2), partial skin graft failure (N = 1), hematoma requiring operative evacuation (N = 1), and partial flap necrosis (N = 1). There were no operative mortalities. Eight patients underwent wide local excision, f lap closure, and brachytherapy. Mean length of hospital stay for this group was 12.3 days compared with 13.8 days for the remaining 11 patie nts. There was one complication (13%) in this group and four complicat ions in the remaining patients (4 of 11; 36%). Our study confirms the utility of soft-tissue reconstruction to permit wide local excision wi th clear margins as well as the delivery of postoperative radiotherapy . It demonstrates the ability of pedicled flaps and free tissue transf ers to remain viable and provide sufficient wound coverage in the sett ing of early postoperative brachytherapy. In addition, this series ill ustrates the efficacy of a team approach and one-stage therapy for ext remity soft-tissue sarcomas that includes excision, reconstruction, an d early postoperative brachytherapy in a single hospitalization.