title: Free tissue transfer in reconstruction following soft tissue sarcoma resection.
abstract: BACKGROUND
  Radical surgical resection remains the single-most important treatment in the curative multimodal therapy of soft tissue sarcomas. Refinements in surgical techniques have resulted in the development of function preserving approaches increasingly avoiding limb amputation.
  
  
  METHODS
  The records of all patients (n = 34) who underwent microsurgical soft tissue coverage subsequent to primary resection of soft tissue sarcoma of the upper or lower limb from 1999 to 2009 are reviewed regarding postoperative complications, time until start of adjuvant radiation and functional outcome (Toronto Extremity Salvage Score, TESS).
  
  
  RESULTS
  Thirty-four patients (range: 21-86 years) received a total of 35 free flaps. Complete tumor resection was obtained in 33 patients, one patient required re-excision ultimately resulting in tumor-free margin status (R0 resection). Major complications were encountered in four cases including one patient with complete flap loss requiring an additional free flap and three patients with partial flap loss requiring split-thickness skin graft procedures. Minor complications were observed in three patients (9%). Extremity salvage could be achieved in 33 patients with adequate postoperative ambulation (TESS 84 ± 18) and adequate use of the upper extremity (TESS 80 ± 22). One patient underwent amputation. Mean time until start of adjuvant radiotherapy was 37 days (range 24-56 days).
  
  
  CONCLUSIONS
  A synergetic center-based interdisciplinary approach is crucial in therapeutical management of soft tissue sarcomas with the aim of R0 resection status and limb preservation. Plastic surgery contributes by offering microsurgical reconstruction using free tissue transfer, thus broadening surgical possibilities. This increases the chance of both adequate oncosurgical resection and limb preservation.
authors.affiliation: Department of Plastic and Hand Surgery, University Medical Center Freiburg, Germany. vincenzo.penna@uniklinik-freiburg.de
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Penna
authors.forename: Niklas
authors.initials: N
authors.lastname: Iblher
authors.forename: Arash
authors.initials: A
authors.lastname: Momeni
authors.forename: G Björn
authors.initials: GB
authors.lastname: Stark
authors.forename: Holger
authors.initials: H
authors.lastname: Bannasch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D055815:Young Adult