The role of free flap reconstruction after resection of extremity and trunk soft tissue sarcomas. Results of two referral centers in Argentina

Introduction

For patients affected by extremity or trunk soft-tissue sarcomas (STS) large resections might be needed to achieve negative margins. This is a common scenario especially in locally advanced or recurrent tumors often within a pre-irradiated field. The objective of this study was to evaluate the results of free-flap reconstructions (FFR) after sarcoma surgery.

Objective

The endpoints were surgical results, quality of surgical margins and oncological outcome.

Methods

Retrospective analysis of patients with extremity and trunk STS with free-flap reconstruction between 2008 and 2022. Demographic and tumor data, perioperative treatment, margin status, morbidity and evolution were evaluated.

Results

Of 467 patients, 25 (5.35%) required 26 free-flap reconstructions. Surgery was performed on an irradiated field in 8 (32%) patients. Reconstructions were mostly needed for distal lower extremity resections and the most common type of flap used was antero-lateral tight (ALT) flap. No R2 resections were performed. R0 and R1 resections were achieved in 22 (84.6%) and 4 (15.4%), respectively. All R1 resections were preplanned positive along a preserved critical structure. Surgical morbidity rate was 26% (7/26) and the re-operation rate was 15% (4/26) with 7.7% flap losses (2/26). At a median follow-up of 38 months, 7 (28%) patients presented local recurrences.

Conclusion

In a referral sarcoma center, having a multidisciplinary surgical team capable of complex resections and reconstructions is of utmost importance for a correct and integral surgical planning. This allows optimal oncologic resections with acceptable morbidity.