Reconstruction of Soft Tissue Defect With a Free Vascularized Anterolateral Thigh Flap After Resection of Soft Tissue Sarcoma in Extremities

Abstract

Objective: This study aims to determine outcomes and complications in functional reconstruction of soft tissue defects after surgical resection for soft tissue sarcomas (STSs) of extremities.

Methods: A retrospective chart review was performed on patients with STSs of extremities from May 2015 to April 2019 who underwent radical resection of STSs and reconstruction of soft tissue defect with free vascularized anterolateral thigh flap (FVALTP). A minimum 3-month follow-up was required for all the patients. Patient demographics and comorbidities, flap characteristics, postoperative complications, and time to heal were recorded. The functional outcomes of the reconstructed limbs were assessed by the Musculoskeletal Tumour Society（MSTS） scoring system.

Results: A total of 11 patients (four males and seven females) were included in the study. The mean age was 62 years (range: 29-84 years). The mean surface area was 151.4 cm² (range: from 64 cm² to 418cm² ). The mean operation time was 126 min (range: 95-296 min). The mean follow-up was 17.5 months (range: 6-34 months). The mean score of MSTS at last follow-up was 26.2 (range: 12-29). Incision healed by first intention in eight patients. Incision healed by second intention in three patients. A patient who had received preoperative radiotherapy experienced delayed union. After debridement, the patient successfully got union. Another two patients experienced marginal necrosis of flap due to vascular crisis. After 3-week dressing changes, the patients also got satisfactory union. One case suffered from vascular crisis during surgery in which the procedure was changed into skin grafting to cover resection site.

Conclusion: FVALTP technique can be effectively applied to the reconstruction of soft tissue defect after STSs resection. The short-term follow-up indicated satisfactory functional outcome and low incidence of previously known complications. It was necessary to further validate its efficacy in reconstruction of soft tissue defect after malignant extremity soft tissue sarcoma resection.

Keywords: Defect; Free vascularized anterolateral thigh flap; Reconstruction; Soft tissue sarcomas.