FUNCTIONAL OUTCOME AFTER SOFT-TISSUE RECONSTRUCTION FOR LIMB SALVAGE AFTER SARCOMA SURGERY

Limb salvage has been achieved for patients with sarcoma by means of c ompartmental resection, soft-tissue reconstruction, and adjuvant thera py without increased rates of local recurrence, metastasis, or mortali ty. Despite the prevalence of limb salvage procedures in the treatment of these tumors, relatively little information has been published reg arding late functional results in these reconstructed extremities. Thi s study reports on the functional outcome for soft-tissue reconstructi on for limb salvage in patients with sarcoma. Over the past 6 years, 2 8 patients were treated for sarcomas of the extremity in which soft-ti ssue reconstruction was needed for complete limb salvage. The mean age of these patients was 48 years (range, 14 to 83 years); there were 14 male and 14 female patients. Of the 28 sarcomas, 23 cases involved th e lower extremity and 5 cases were in the upper extremity, Reconstruct ion was performed primarily in 12 patients; 16 reconstructions were pe rformed secondarily because of wound complications after initial extir pation. Adjuvant radiation therapy was administered either preoperativ ely or postoperatively in all cases. Of the 33 reconstructive procedur es performed in these 28 patients, 16 involved free flaps and 17 invol ved local flaps. All patients achieved initial limb salvage after the reconstructive procedure(s). Mean follow-up was 38 months. Twenty pati ents were available for the evaluation portion of the study. Two patie nts had delayed amputations: one for recurrent disease and another for osteoradionecrosis. Two patients died before beginning the examinatio n process: one patient from the sarcoma and another patient from colon cancer. Twenty of the remaining 24 patients agreed to participate and were examined using the Enneking outcome measurement scale. Patients were examined for range of motion, deformity, stability, pain level, s trength, functional activity, and emotional acceptance and assigned a numerical score for each category. Based on this, an overall rating of excellent, good, fair, or poor was assigned. Nine patients (45 percen t) achieved an overall rating of excellent, five patients (25 percent) achieved a rating of good, and six patients (30 percent) achieved a f air score. None had received a rating of poor. There were no differenc es in the results obtained comparing upper versus lower extremity, imm ediate versus delayed reconstruction, or reconstructions performed wit h a free flap versus a pedicled flap. This study supports the continue d use of soft-tissue reconstruction for limb salvage in sarcoma surger y with good to excellent late functional results obtained in the major ity of patients.