title: Limb salvage surgery with microsurgical reconstruction for the treatment of musculoskeletal tumours involving the upper extremity.
abstract: Microsurgical reconstructive techniques have been applied in the management of 14 patients with malignant bone and soft tissue tumours as well as for 30 patients with benign but aggressive bone lesions affecting the upper extremity. Vascularised bone grafts were used in 6 patients with malignant bone tumours and 30 patients with aggressive bone lesions. Reconstruction with soft tissue free flap transfer was required in 6 patients with soft tissue defects, primarily following excision of soft tissue tumours in 2 and after excision of recurrent tumours in 4 patients. Microneural dissection and vascular reconstruction were performed in 2 patients with tumours around the major neurovascular bundles. The patients were followed up for varying periods, ranging from 1 to 12 years and assessment of the limb function was performed using Enneking's system of evaluation. There were no local recurrences. In the malignant tumour group, 3 patients died of systemic disease, 7 were alive but with disease and 4 were disease free. Extremity function was excellent in 3 patients, good in 6 patients, fair in 4 patients and poor in 1 patient. In the benign bone tumour group, extremity function was graded as excellent in 12 patients, good in 14 patients, fair in 3 patients and poor in 1 patient. The vascular bone grafts united in all but 3 patients at 4 months following surgery. Minimal donor site complications had been recorded and there had been no failures. Useful limb salvage may thus be achieved with the application of microsurgical techniques for a variety of indications in limb salvage surgery after tumour excision.
authors.affiliation: Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin NT, Hong Kong.
authors.forename: S M
authors.initials: SM
authors.lastname: Kumta
authors.forename: K M
authors.initials: KM
authors.lastname: Yip
authors.forename: Y L
authors.initials: YL
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Lin
authors.forename: P C
authors.initials: PC
authors.lastname: Leung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm / Q000601:surgery*; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D002813:Chondrosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005354:Fibrosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome