TITLE:
Single Stage Oncologic Resection and Reconstruction: A Step toward Development of Sarcoma Service in Resource Constrained Country
AUTHORS:
Haroon ur Rashid, Kashif Abbas, Masood Umer
KEYWORDS:
Musculoskeletal Tumor; Reconstruction; Flap
JOURNAL NAME:
Modern Plastic Surgery,
Vol.3 No.4,
October
25,
2013
ABSTRACT: Tumor free-margin surgical resection remains the single most
important treatment in the curative therapy of musculoskeletal tumor of limbs.
Refinements in surgical techniques have led to increased
function preservation and limb salvage. Patients and Methods: The records of patients (n = 24) who underwent microsurgical soft tissue
reconstruction subsequent to resection of limb tumour during the period 2006 to
2011 were reviewed. Primary outcome i.e. uptake of the flap was evaluated. Perioperative morbidities were also noted including donor as well as
recipient site complications. Assessment of Functional outcome (Musculoskeletal
Tumor Society score, MSTS) local recurrence, free survival, and
disease-specific survival was also made. Results: Twenty four patients (age range: 7 - 72 years) who have undergone tumor resection
followed by flap coverage were identified. Lower limb reconstruction
outnumbered upper limb by 6:1. Complications included, one complete failure of
free vascularized iliac crest flap done for reconstruction of a heel defect.
One of the patients had secondary hemorrhage 10 days after surgery. Another patient with internal
hemipelvectomy for Ewing’s sarcoma had a dura
puncture during resection of sacrum. Partial epidermal necrosis was evident in
four cases. Eighty three percent of the patients remained alive (n = 20), 19 of
whom currently have no evidence of disease (NED) Disease recurrence was noted
in three patients. Overall MSTS score was 73.5%. Conclusion: The microsurgical repair of defects is
a reliable option that, though not free of complications, is necessary in
selected cases. The procedure enables both adequate oncosurgical resection and
function preservation.