Nerve graft reconstruction of irradiated oncologic segmental nerve defects in the extremities: A case series

Abstract

Background

Neurovascular involvement of extremity neoplasms is historically considered a contraindication for limb-salvage surgery, due to concerns of limb dysfunction secondary to motor and/or sensory loss. Theoretically, large nerve defects may be amenable to reconstruction using grafts, but the outcomes of these techniques in irradiated oncologic patients remain unclear.

Methods

This study investigates reconstruction of oncologic nerve defects in the extremities in patients who underwent (neo)adjuvant radiotherapy. A retrospective series of ten patients with extremity sarcoma is provided, with six lower extremity and four upper extremity cases. Reconstruction consisted of nerve grafting with or without the addition of tendon transfers. The mean duration of clinical follow-up was 42.5 months.

Results

Nerve graft reconstruction led to recovery of motor or sensory function in eight out of ten patients thereby allowing functional limb preservation, with none of the patients developing significant neuropathic pain, a common complication in oncologic resections of the extremities with nerve involvement or following amputation. Thus, radiotherapy does not seem to completely preclude successful graft reconstruction of large oncologic extremity nerve defects.

Conclusions

Although the oncologic disease itself is associated with significant mortality, the results of the nerve reconstruction were encouraging despite the concomitant use of radiation. Based on the available data and literature, we recommend to at least discuss the option of graft-based nerve reconstruction with affected patients if relevant characteristics such as patient comorbidities and the viability of recipient muscle are favorable.

Synopsis

In this study, the results of nerve graft reconstruction of large sarcoma-related nerve defects were evaluated. This type of reconstruction seems feasible even in irradiated limbs, thereby aiding in functional limb preservation.