Soft tissue sarcomas represent 6000 new cases per year with 50% located in the extremities. Prospective studies show no survival or local recurrence benefit with major limb amputations versus limb preservation. At our center, limb sarcomas are treated with limb preservation surgery, whenever possible, by wide tumor resection, immediate soft tissue reconstruction, and adjuvant therapy. This is a retrospective analysis of the limb-salvage surgeries performed at our center by a multidisciplinary team of plastic surgeons, radiation oncologists, and orthopedic surgeons.

Between December 1998 and December 2001 (37 mo), 61 patients (M=42, F=19) underwent 62 limb salvage procedures (42 lower extremity, 20 upper extremity) with 67 flaps. Mean follow-up has been 12.5 +/- 8.9 mo. (range: 1–32 mo). Malignant fibrous histiocytoma was the most common diagnosis (n=26). 44 (72.1%) tumors were high-grade. The thigh was the most common location (n=24). The rectus abdominis (n=26), latissimus dorsi (n=15), and the gracilis (n=7) were the most common flaps. 29 were free flaps, with one acute loss (3.3%) and two late losses (6.8%). All pedicle flaps survived. The total flap survival rate for both pedicle and free flap was 95.5%. 29 patients had concurrent surgeries; the most common being tendon reconstruction. Mean surgery time was 8.2 +/- 3.2 hrs. The mean hospital stay was 7.6 +/- 3.7 days.

28 patients had preoperative and 39 had postoperative adjuvant therapy (chemotherapy or radiation) and. Those with postoperative brachytherapy were started at 7.50.7 days. No flaps were lost to the effects of brachytherapy. Wound complications were seen in 30 (49%), most commonly seroma (n=12). There were 9 non-wound related complications (14.8%), the most common being nerve palsy (n=4). 15 patients (24.6%) had surgery for their complications: seroma drainage (n=6), wound debridement (n=6). Perioperative mortality was zero. 3 had metastasis at the time of the limb salvage surgery. 10 later developed metastasis. The most common site was the lung. 1 had local recurrences and 1 had a local recurrence. 3 patients have died, surviving 11.04.3 mo. after their surgery.

Limb functionality was graded as excellent (defined by return to preoperative level), moderate (functional but limited in range or strength), or poor (severe limitation due to pain or poor motion). 37 have regained full limb use. 18 have moderate use. 4 have limited use. Overall, 55 (93.2%) have full to moderate limb function. No limbs have been amputated.

This is a continuing analysis of our experience with limb salvage for sarcomas. Our data indicate that limb salvage surgery does provide the patient with useful and functional limbs. Although the complication rate was high, particularly for wound healing, we feel that limb salvage should be performed whenever possible to avoid the morbidities associated with amputations.