Thumb reconstruction following resection for malignant tumors.
BACKGROUND
Although limb salvage is possible for most extremity sarcomas, amputation has often been advocated as the treatment of choice for tumors involving the digits. The thumb poses a dilemma, however, because loss of its function can severely impair the use of the hand and entire upper limb. The authors report their experience with thumb reconstruction following wide excision of bone and soft-tissue tumors of the thumb.


METHODS
This was a retrospective review of all patients who underwent excision of thumb or first ray tumors between 1994 and 2005 followed by reconstruction at Memorial Sloan-Kettering Cancer Center. Patient demographics, tumor pathologic findings, ablative and reconstructive operations performed, postoperative adjuvant therapy, recurrence, and survival were analyzed. Function and reconstruction outcomes were assessed.


RESULTS
Seventeen patients were identified with bone or soft-tissue sarcomas, melanoma, or squamous cell carcinoma. Median follow-up was 33 months (range, 6 to 105 months; mean, 47 months). Negative resection margins were achieved in all patients. Of the 16 patients who underwent reconstruction, three had a reconstruction using free tissue transfer, four had a pedicled flap, one had an axial based local flap, one had a fillet flap, and seven achieved wound closure directly or with the use of skin grafts. The mean American Musculoskeletal Tumor Society Score following reconstruction was 28.8 (95.8 percent).


CONCLUSIONS
Thumb reconstruction and salvage after tumor resection following wide excision is technically possible. Reconstruction following accepted reconstructive principles and techniques can result in acceptable functional outcomes with low risk of complication.
Mehrara
Babak J
BJ
New York, N.Y. From the Department of Surgery, Division of Orthopedic Surgery, and the Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center.
Abood
Ahid A
AA
Disa
Joseph J
JJ
Pusic
Andrea L
AL
Halvorson
Eric
E
Cordeiro
Peter G
PG
Athanasian
Edward A
EA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013933:Thumb / Q000601:surgery*