Thumb reconstruction following resection for malignant tumors Journal Article


Authors: Mehrara, B. J.; Abood, A. A.; Disa, J. J.; Pusic, A. L.; Halvorson, E.; Cordeiro, P. G.; Athanasian, E. A.
Article Title: Thumb reconstruction following resection for malignant tumors
Abstract: BACKGROUND: Although limb salvage is possible for most extremity sarcomas, amputation has often been advocated as the treatment of choice for tumors involving the digits. The thumb poses a dilemma, however, because loss of its function can severely impair the use of the hand and entire upper limb. The authors report their experience with thumb reconstruction following wide excision of bone and soft-tissue tumors of the thumb. METHODS: This was a retrospective review of all patients who underwent excision of thumb or first ray tumors between 1994 and 2005 followed by reconstruction at Memorial Sloan-Kettering Cancer Center. Patient demographics, tumor pathologic findings, ablative and reconstructive operations performed, postoperative adjuvant therapy, recurrence, and survival were analyzed. Function and reconstruction outcomes were assessed. RESULTS: Seventeen patients were identified with bone or soft-tissue sarcomas, melanoma, or squamous cell carcinoma. Median follow-up was 33 months (range, 6 to 105 months; mean, 47 months). Negative resection margins were achieved in all patients. Of the 16 patients who underwent reconstruction, three had a reconstruction using free tissue transfer, four had a pedicled flap, one had an axial based local flap, one had a fillet flap, and seven achieved wound closure directly or with the use of skin grafts. The mean American Musculoskeletal Tumor Society Score following reconstruction was 28.8 (95.8 percent). CONCLUSIONS: Thumb reconstruction and salvage after tumor resection following wide excision is technically possible. Reconstruction following accepted reconstructive principles and techniques can result in acceptable functional outcomes with low risk of complication. ©2008American Society of Plastic Surgeons.
Keywords: adolescent; adult; cancer survival; child; clinical article; controlled study; school child; aged; bone neoplasms; middle aged; bone tumor; cancer surgery; excision; reconstructive surgical procedures; retrospective studies; cancer recurrence; case report; plastic surgery; squamous cell carcinoma; carcinoma, squamous cell; postoperative care; follow up; methodology; demography; melanoma; retrospective study; sarcoma; experience; scoring system; soft tissue sarcoma; free tissue graft; pedicled skin flap; wound closure; soft tissue neoplasms; soft tissue tumor; skin graft; bone cancer; tissue flap; hand tumor; soft tissue cancer; thumb; thumb injury; thumb reconstruction
Journal Title: Plastic and Reconstructive Surgery
Volume: 121
Issue: 4
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2008-04-01
Start Page: 1279
End Page: 1287
Language: English
DOI: 10.1097/01.prs.0000304590.09003.1b
PUBMED: 18349647
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 17 November 2011" - "CODEN: PRSUA" - "Source: Scopus"
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MSK Authors
  1. Joseph Disa
    214 Disa
  2. Andrea Pusic
    292 Pusic
  3. Babak Mehrara
    288 Mehrara
  4. Peter G Cordeiro
    254 Cordeiro