title: Analysis of immediate vascular reconstruction for lower-limb salvage in patients with lower-limb bone and soft-tissue sarcoma.
abstract: BACKGROUND
  Limb amputation has historically been the first choice of treatment for patients with bone or soft-tissue sarcomas involving major blood vessels. However, recent advances in surgical technique have allowed limb-salvage surgery. We reviewed our experiences with limb-salvage surgery and immediate vascular reconstruction following en bloc resection of bone or soft-tissue sarcomas of the lower extremity.
  
  
  METHODS
  We reviewed 23 patients (15 male and eight female; mean age, 43.6 years) who underwent limb-salvage surgery and immediate vascular reconstruction. Details of surgical factors and postoperative complications were evaluated.
  
  
  RESULTS
  Reconstructed vessels remained patent in 21 cases. The rate of limb oedema was higher in patients who underwent only arterial reconstruction after arteriovenous resection. Twenty patients could walk well without crutches a few months after reconstructive surgery. All patients avoided amputation. Two patients died of disseminated disease within 3 years after surgery.
  
  
  CONCLUSIONS
  The high rate of limb oedema suggests that venous reconstruction is necessary after arteriovenous resection. Vascular reconstruction and musculocutaneous flap techniques are useful in limb-salvage surgery and are indicated for patients who have achieved good disease control. Evidence Rating Scale for Therapeutic Studies: Level III.
authors: Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan. s8013@nms.ac.jp
authors: Hiroki
authors: H
authors: Umezawa
authors: Minoru
authors: M
authors: Sakuraba
authors: Shinpei
authors: S
authors: Miyamoto
authors: Shougo
authors: S
authors: Nagamatsu
authors: Shuji
authors: S
authors: Kayano
authors: Megumi
authors: M
authors: Taji
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult