Reconstruction of massive oncologic defects following extremity amputation: a 10-year experience.
BACKGROUND
Oncologic defects resulting from extremity amputations are often extensive and require substantial soft tissue for reconstruction.


METHODS
A review of all patients, who underwent an external hemipelvectomy, forequarter amputation, or hindquarter amputation from 2001 to 2010 at the MD Anderson Cancer Center, was performed.


RESULTS
A total of 50 patients were identified; of them, 21 underwent external hemipelvectomy, 22 had forequarter amputation, and 7 had hindquarter amputation. The mean defect size was 644 cm; defects were repaired using fillet flaps (n = 22, 44%), free flaps (n = 4, 8%), or local/regional flaps (n = 24, 48%). Of the fillet flaps, 16 were free flaps and the remaining were pedicled flaps. In all, 29 patients (58%) received preoperative radiation therapy, and 26 patients (52%) received preoperative chemotherapy. Two patients (4%) received postoperative radiation therapy, and 1 patient (2%) received postoperative chemotherapy. Three patients received both pre- and postoperative radiation therapy, and 10 patients were treated with both pre- and postoperative chemotherapy. Patients undergoing free flap reconstruction had significantly fewer complications compared with patients reconstructed using other modalities (2/20 vs. 13/30; P = 0.003). The majority of patients achieved excellent postoperative function, with 73% of upper extremity patients functioning independently and 57% of lower extremity amputees ambulating.


CONCLUSIONS
Reconstruction for extensive defects following oncologic extremity amputation is often optimally done using free tissue transfer, particularly by salvaging "spare parts" from the amputated limb for a free fillet flap.
Department of Plastic Surgery, University of Tennessee, Health Sciences Center, Germantown, TN, USA.
Maanasi
M
Samant
Edward I
EI
Chang
Jason
J
Petrungaro
Jon P
JP
Ver Halen
Peirong
P
Yu
Roman J
RJ
Skoracki
David W
DW
Chang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000401:mortality / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006428:Hemipelvectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000401:mortality; D020127:Recovery of Function; D012189:Retrospective Studies; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult