The Role of Reconstructive Surgery in Lower Extremity Soft Tissue Sarcoma

Abstract

Purpose of Review: Soft tissue sarcomas (STS) are relatively rare cancers, commonly occurring in the extremities. Over the last decades a shift in the treatment of extremity STS has occurred, from limb amputations toward so-called limb salvage surgery (LSS). This review provides an overview of the current surgical treatment options for lower extremity STS and how the role of reconstructive surgery may evolve in the coming years toward optimizing functional outcomes and improving the quality of life in these patients. Recent Findings: Recent research has shown that having a low threshold for advanced reconstructive techniques, with the goal of bringing well-vascularized tissue to the defect, may lower the wound complication rates, especially in preoperatively irradiated tumors. Careful preoperative planning should not only include an optimal balance between complete surgical resection and preservation of vital structures, but also the possibilities of restoring anticipated loss of function. Such functional reconstructions may include the use of free functional muscle transfers but also tendon transfers and any type of nerve reconstruction. A more recent development is lymphatic surgery for STS patients to prevent or treat lymphorrhea and lymphedema. Future prospective studies should further study the indications, the timing of the surgery, and measure the outcomes of the lymphatic surgical techniques to further gain insights into the efficacy. Summary: Novel techniques such as functional reconstructions, nerve transfers, and lymphatic surgery are within the realms of reconstructive options and therefore, it is important that patients with a STS are taken care of in centers that have a multidisciplinary team with a reconstructive surgeon as a member.