title: Functional evaluation after reconstruction with myocutaneous and fasciocutaneous flaps for conservative oncological surgery of the extremities.
abstract: BACKGROUND
  Limb-preservation surgery has evolved during the last two decades through application of pedicled and free flaps and has obtained oncological results similar to those with amputation for malignant neoplasms of the extremities. However, functional evaluation has not been performed comprehensively after these advanced reconstructive procedures. The aim of this study was to describe the oncological, surgical, and functional outcomes achieved in these patients.
  
  
  METHODS
  Patients had malignant neoplasms of the extremities and/or shoulder and hip girdle, underwent resective surgery and reconstruction with limb-preservation purposes, and were treated from 1997 to 2002. Survival analysis was performed, and functional evaluation after resection was performed with the Enneking system 1 year after surgery.
  
  
  RESULTS
  Thirty-two patients were included. The mean overall survival of the cohort was 5.6 years. Functional evaluation mean rating percentages for the upper and lower extremities were 86.5% and 75.2%. Functional outcomes were better for reconstruction with free flaps than with pedicled flaps in the lower extremities (rating percentages, 67% and 79.6%, respectively; P = .018).
  
  
  CONCLUSIONS
  Limb-preservation surgery is a safe treatment for malignant neoplasms. It can be performed with low morbidity and good oncological outcomes. Functional results in our series were good. Lower limb preservation has superior scores with free flap reconstructions because of their potential to cover extensive defects, and better results were obtained in walking, gait, and weight bearing.
authors.affiliation: Plastic Surgery Service, Surgery Division, Instituto Nacional de Cancerologia, San Fernando 22, México D.F., 14080, Mexico. berba@prodigy.net.mx
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rivas
authors.forename: José F
authors.initials: JF
authors.lastname: Carrillo
authors.forename: Luis F
authors.initials: LF
authors.lastname: Oñate-Ocaña
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D005121:Extremities / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D016879:Salvage Therapy; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D018709:Statistics, Nonparametric; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome