CC BY-NC-ND 4.0 · Indian J Plast Surg 2019; 52(01): 055-061
DOI: 10.1055/s-0039-1688101
Review Article
Association of Plastic Surgeons of India

Sarcoma of the Lower Limb: Reconstructive Surgeon's Perspective

Zhixue Lim
1   Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore, Singapore
,
Sophia A. Strike
1   Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore, Singapore
,
Mark E. Puhaindran
1   Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore, Singapore
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
08. Mai 2019 (online)

Abstract

Management of sarcomas in the lower extremities have evolved from amputations to limb-preserving surgeries with evidence to support that they have equal overall survival, albeit with better functional outcome. The challenge of reconstruction lies in providing a durable, functional, and aesthetically pleasing limb. However, limb-preserving intention should not delay interventions that provide a survival benefit such as chemotherapy and radiotherapy. The advent of radiotherapy and chemotherapy also has implications on wound healing and should be considered during the reconstructive process. This article reviews the methodical approach, reconstructive strategies, and considerations for the reconstructive surgeon with respect to the lower extremity after sarcoma excision.

 
  • References

  • 1 Sondak VK. Sarcomas of bone and soft tissue. In Greenfield LJ, Mulholland MW, Oldham KT, Zelenock GB, Lillemoe KD. eds. Surgery: Scientific Principles and Practice. 3rd ed.. Philadelphia: Lippincott Williams & Wilkins; 2000: 2258-2280
  • 2 Weitz J, Antonescu CR, Brennan MF. Localized extremity soft tissue sarcoma: improved knowledge with unchanged survival over time. J Clin Oncol 2003; 21 (14) 2719-2725
  • 3 Gross SW. The classic: sarcoma of the long bones: based upon a study of one hundred and sixty-five cases. Clin Orthop Relat Res 1975; (111) 5-13
  • 4 Phermister DB. The classic: conservative bone surgery in the treatment of bone tumours 1940. Clin Orthop Relat Res 1986; (204) 4-8
  • 5 Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am 1994; 76 (05) 649-656
  • 6 Beane JD, Yang JC, White D, Steinberg SM, Rosenberg SA, Rudloff U. Efficacy of adjuvant radiation therapy in the treatment of soft tissue sarcoma of the extremity: 20-year follow-up of a randomized prospective trial. Ann Surg Oncol 2014; 21 (08) 2484-2489
  • 7 Mahmoud O, Tunceroglu A, Chokshi R. et al. Overall survival advantage of chemotherapy and radiotherapy in the perioperative management of large extremity and trunk soft tissue sarcoma; a large database analysis. Radiother Oncol 2017; 124 (02) 277-284
  • 8 Bielack S, Carrle D, Casali PG. ESMO Guidelines Working Group. Osteosarcoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20 (04) (Suppl. 04) 137-139
  • 9 Jacobs EM. Combination chemotherapy of metastatic testicular germinal cell tumors and soft part sarcomas. Cancer 1970; 25 (02) 324-332
  • 10 O'Bryan RM, Baker LH, Gottlieb JE. et al. Dose response evaluation of adriamycin in human neoplasia. Cancer 1977; 39 (05) 1940-1948
  • 11 Prendergast B, Fiveash JB, Gibbs CP, Scarborough MT, Indelicato DJ. Radiotherapy for soft tissue sarcoma of the proximal lower extremity. Sarcoma 2010; 2010 829498
  • 12 Sharma K, Marcus JR. Bevacizumab and wound-healing complications: mechanisms of action, clinical evidence, and management recommendations for the plastic surgeon. Ann Plast Surg 2013; 71 (04) 434-440
  • 13 O'Sullivan B, Davis AM, Turcotte R. et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 2002; 359 9325 2235-2241
  • 14 Gan AW, Puhaindran ME, Pho RW. The reconstruction of large bone defects in the upper limb. Injury 2013; 44 (03) 313-317
  • 15 Uzel AP, Lemonne F, Casoli V. Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced membrane. Orthop Traumatol Surg Res 2010; 96 (02) 194-198
  • 16 Ilizarov GA. Principes fondamentaux de l'ostéosynthèse en compression-distraction. Ortop Travmatol Protez 1971; 32 (11) 7-15
  • 17 Cattaneo R, Villa A, Catagni M, Tentori L. Traitement des pseudarthroses septiques ou non septiques selon la méthode d'Ilizarov en compression monofocale. Rev Chir Orthop Repar Appar Mot 1985; 71: 223-239
  • 18 Weiland AJ, Moore JR, Daniel RK. Vascularized bone autografts. Experience with 41 cases. Clin Orthop Relat Res 1983; (174) 87-95
  • 19 Plakseychuk AY, Kim SY, Park BC, Varitimidis SE, Rubash HE, Sotereanos DG. Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am 2003; 85-A (04) 589-596
  • 20 Tetik C, Başar H, Bezer M, Erol B, Ağir I, Esemenli T. Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Acta Orthop Traumatol Turc 2011; 45 (05) 326-334
  • 21 Kim SY, Kim YG, Kim PT, Ihn JC, Cho BC, Koo KH. Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone Joint Surg Am 2005; 87 (09) 2012-2018
  • 22 Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 55 (05) 533-544
  • 23 Chen CM, Disa JJ, Lee HY. et al. Reconstruction of extremity long bone defects after sarcoma resection with vascularized fibula flaps: a 10-year review. Plast Reconstr Surg 2007; 119 (03) 915-924 discussion 925–926
  • 24 Beris AE, Lykissas MG, Korompilias AV. et al. Vascularized fibula transfer for lower limb reconstruction. Microsurgery 2011; 31 (03) 205-211
  • 25 del Piñal F, Innocenti M. Evolving concepts in the management of the bone gap in the upper limb. Long and small defects. J Plast Reconstr Aesthet Surg 2007; 60 (07) 776-792
  • 26 Capanna R, Bufalini C, Campanacci M. A new technique for reconstructions of large metadiaphyseal bone defects, a combined graft (Allograft shell plus vascularised fibula). Orthop Traumatol Surg Res 1993; 2 (03) 159-177
  • 27 Taguchi Y, Pereira BP, Kour AK, Pho RW, Lee YS. Autoclaved autograft bone combined with vascularized bone and bone marrow. Clin Orthop Relat Res 1995; (320) 220-230
  • 28 Puhaindran ME, Pho RW. Biological reconstruction for children with osteosarcoma around the knee. Ann Acad Med Singapore 2014; 43 (10) 499-505
  • 29 Schwartz AJ, Kabo JM, Eilber FC, Eilber FR, Eckardt JJ. Endoprosthetic reconstruction after resection of musculoskeletal tumors. Am J Orthop 2014; 43 (03) 122-127
  • 30 Hanna SA, Sewell MD, Aston WJ. et al. Femoral diaphyseal endoprosthetic reconstruction after segmental resection of primary bone tumours. J Bone Joint Surg Br 2010; 92 (06) 867-874
  • 31 Aldlyami E, Abudu A, Grimer RJ, Carter SR, Tillman RM. Endoprosthetic replacement of diaphyseal bone defects. Long-term results. Int Orthop 2005; 29 (01) 25-29
  • 32 Fuchs B, Ossendorf C, Leerapun T, Sim FH. Intercalary segmental reconstruction after bone tumor resection. Eur J Surg Oncol 2008; 34 (12) 1271-1276
  • 33 Rabitsch K, Maurer-Ertl W, Pirker-Frühauf U, Wibmer C, Leithner A. Intercalary reconstructions with vascularised fibula and allograft after tumour resection in the lower limb. Sarcoma 2013; 2013: 160295
  • 34 Ruggieri P, Mavrogenis AF, Bianchi G, Sakellariou VI, Mercuri M, Papagelopoulos PJ. Outcome of the intramedullary diaphyseal segmental defect fixation system for bone tumors. J Surg Oncol 2011; 104 (01) 83-90
  • 35 Sauerbruch VF. Dies exstirpation des femur mit Umkipp-Plastik des Unterschenkels. Deutsche Zeitschrift fur Chirugie 1922; 169: 1
  • 36 Salzer M, Knahr K, Kotz R, Kristen H. Treatment of osteosarcomata of the distal femur by rotation-plasty. Arch Orthop Trauma Surg 1981; 99 (02) 131-136
  • 37 Hopyan S, Tan JW, Graham HK, Torode IP. Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone. J Pediatr Orthop 2006; 26 (03) 405-408
  • 38 Catani F, Capanna R, Benedetti MG. et al. Gait analysis in patients after Van Nes rotationplasty. Clin Orthop Relat Res 1993; (296) 270-277
  • 39 Gottsauner-Wolf F, Kotz R, Knahr K, Kristen H, Ritschl P, Salzer M. Rotationplasty for limb salvage in the treatment of malignant tumors at the knee. A follow-up study of seventy patients. J Bone Joint Surg Am 1991; 73 (09) 1365-1375
  • 40 Nishinari K, Wolosker N, Yazbek G, Zerati AE, Nishimoto IN. Venous reconstructions in lower limbs associated with resection of malignancies. J Vasc Surg 2006; 44 (05) 1046-1050
  • 41 Nishinari K, Wolosker N, Yazbek G. et al. Vascular reconstruction in limbs with malignant tumors. Vasc Endovascular Surg 2004; 38 (05) 423-429
  • 42 Nishinari K, Krutman M, Aguiar JuniorS. et al. Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities. J Vasc Surg 2015; 62 (01) 143-149
  • 43 Tsukushi S, Nishida Y, Sugiura H, Nakashima H, Ishiguro N. Results of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma in the lower extremity: comparison between only arterial and arterovenous reconstruction. J Surg Oncol 2008; 97 (03) 216-220
  • 44 Kawai A, Hashizume H, Inoue H, Uchida H, Sano S. Vascular reconstruction in limb salvage operations for soft tissue tumors of the extremities. Clin Orthop Relat Res 1996; (332) 215-222
  • 45 Pinsolle V, Reau AF, Pelissier P, Martin D, Baudet J. Soft-tissue reconstruction of the distal lower leg and foot: are free flaps the only choice?. Review of 215 cases. J Plast Reconstr Aesthet Surg 2006; 59 (09) 912-917 discussion 918
  • 46 Parrett BM, Matros E, Pribaz JJ, Orgill DP. Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures. Plast Reconstr Surg 2006; 117 (04) 1315-1322 discussion 1323–1324
  • 47 Cordeiro PG, Neves RI, Hidalgo DA. The role of free tissue transfer following oncologic resection in the lower extremity. Ann Plast Surg 1994; 33 (01) 9-16
  • 48 Lin CH, Lin YT, Yeh JT, Chen CT. Free functioning muscle transfer for lower extremity posttraumatic composite structure and functional defect. Plast Reconstr Surg 2007; 119 (07) 2118-2126
  • 49 Wechselberger G, Pichler M, Pülzl P, Schoeller T. Free functional rectus femoris muscle transfer for restoration of extension of the foot after lower leg compartment syndrome. Microsurgery 2004; 24 (06) 437-441
  • 50 Hallock GG. Restoration of quadriceps femoris function with a dynamic microsurgical free latissimus dorsi muscle transfer. Ann Plast Surg 2004; 52 (01) 89-92
  • 51 Willcox TM, Smith AA, Beauchamp C, Meland NB. Functional free latissimus dorsi muscle flap to the proximal lower extremity. Clin Orthop Relat Res 2003; (410) 285-288
  • 52 Ihara K, Shigetomi M, Kawai S, Doi K, Yamamoto M. Functioning muscle transplantation after wide excision of sarcomas in the extremity. Clin Orthop Relat Res 1999; (358) 140-148
  • 53 Kobayashi S, Sekiguchi J, Sakai Y, Ohmori K. Functioning free muscle transplantation to the lower leg. J Reconstr Microsurg 1995; 11 (05) 319-325
  • 54 Markhede G, Stener B. Function after removal of various hip and thigh muscles for extirpation of tumors. Acta Orthop Scand 1981; 52 (04) 373-395
  • 55 Goldthwait JE. The direct transplantation of muscles in the treatment of paralytic deformities. Trans Am Orthop Assoc 1897; 10: 246-252
  • 56 Pritsch T, Malawer MM, Wu CC, Squires MH, Bickels J. Functional reconstruction of the extensor mechanism following massive tumor resections from the anterior compartment of the thigh. Plast Reconstr Surg 2007; 120 (04) 960-969
  • 57 Dubousset J, Missenard G, Genin J. [Conservative surgical treatment of osteogenic sarcoma of the limbs. Technics and functional results]. Rev Chir Orthop Repar Appar Mot 1985; 71 (07) 435-450
  • 58 Muramatsu K, Ihara K, Miyoshi T, Yoshida K, Hashimoto T, Taguchi T. Transfer of latissimus dorsi muscle for the functional reconstruction of quadriceps femoris muscle following oncological resection of sarcoma in the thigh. J Plast Reconstr Aesthet Surg 2011; 64 (08) 1068-1074