Limb-sparing surgery with reinnervated free-muscle transfer following radical excision of soft-tissue sarcoma in the extremity

Limb-sparing surgery is the preferred approach in the management of patient s with high-grade soft-tissue sarcomas when local disease can be completely resected. However, conventional treatment focuses only on restoration of b asic functions to the remnant limb. Lost functions are not restored to norm al, leaving the patient with variable degrees of functional disabilities. T his in turn may necessitate further massive reconstructive procedures. Transferred reinnervated free muscles were used to reconstruct functions lo st after radical resection of malignant soft-tissue sarcoma of the extremit ies in 17 patients. The long-term functional outcome included survival of t ransplanted muscle, speed of neural recovery, and muscle strength and disab ilities. All muscles survived. Postoperative follow up ranged from 27 to 106 months. AU muscles except those in a 75-year-old patient were successfully reinner vated. Powerful strength and almost normal limb functions were obtained. Fu nctional scoring of the patients according to the rating system of the Musc uloskeletal Tumor Society was 87 percent for the lower extremity and 93 per cent for the upper extremity. All patients are presently disease-free. Use of the reinnervated free-muscle transfer in limb-sparing surgery after resection of soft-tissue sarcoma in the extremity may be indicated in the y oung adult when radical excision of the tumor will result in severe motor f unctional loss, provided adequate clearance can be obtained and that there is no presence of distant metastasis.