Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction Journal Article

Authors: Mastorakos, D. P.; Disa, J. J.; Athanasian, E.; Boland, P.; Healey, J. H.; Cordeiro, P. G.
Article Title: Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction
Abstract: Limb salvage after extremity tumor ablation may include the use of allograft bone. The primary complication of this method is infection of the allograft, which call lead to limb loss in up to 50 percent of cases. The purpose of this study is to evaluate the efficacy of primary muscle flap coverage in the setting of allograft bone limb salvage surgery. This study is a prospective review of all patients with flap coverage of extremity allografts over the 10-year period 1991 to 2001. There were 20 patients (11 male and nine female patients) with all average age of 28 years (range, 6 to 72 years). Flap coverage was primary in 16 patient: and delayed in four. Delayed coverage was performed for failed wounds that did not have a primary soft-tissue flap. Pathologic findings included osteosarcoma in nine patients, Ewing sarcoma in five patients, malignant hibrohistiocytoma in two patients, chondrosarcoma in two patients, synovial sarcoma in one patient, and leiomyosarcoma in one patient. Allograft reconstruction was performed for the upper extremity in 12 patients and for the lower extremity in eight patients. Flap reconstruction was accomplished with 20 pedicle flaps in 17 patients (latissimus dorsi, 12; gastrocnemius, four; soleus, three; and fasciocutaneous flap, one) and four free flaps (rectus abdominis, three; latissimus dorsi, one) in four patients. All pedicled flaps survived. There was one flap failure in the entire series, which was a free rectus abdominis flap. This case resulted in the only limb loss noted. The follow-up period ranged from I to 50 months (average, 12.35 months). At the time of final follow-up, three patients were dead of disease and 17 were alive with intact extremities. The overall limb salvage rate in the setting of bone allograft and soft-tissue flap coverage was 95 percent (19 of 20). Reoperation for bone-related complications was required in 50 percent (two of four) of cases receiving delayed flap coverage compared with 19 percent (three of 16) of patients with primary flap coverage (statistically, not significant). The results of this study support the use of soft-tissue flap coverage for allograft limb reconstruction. In this series, no limb was lost in the setting of a viable flap. Reoperation was markedly reduced in the setting of primary flap coverage. Pedicled or microvascular transfer of well-vascularized muscle can be used to wrap the allograft and minimize devastating wound complications potentially leading to loss of allograft and limb.
Keywords: muscle flap; tumors
Journal Title: Plastic and Reconstructive Surgery
Volume: 109
Issue: 5
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2002-04-15
Start Page: 1567
End Page: 1573
Language: English
ACCESSION: WOS:000174827900012
DOI: 10.1097/00006534-200204150-00012
PUBMED: 11932598
Notes: Presented at the 54th Annual Meeting of the Society of Surgical Oncology; 2001 Mar 15-18; Washington, DC -- Source: Wos
Citation Impact
MSK Authors
  1. Patrick J Boland
    143 Boland
  2. Joseph Disa
    214 Disa
  3. Peter G Cordeiro
    254 Cordeiro
  4. John H Healey
    445 Healey