title: Reconstruction of sarcoma defects following pre-operative radiation: free tissue transfer is safe and reliable.
abstract: BACKGROUND
  Neoadjuvant radiotherapy followed by surgical resection and soft tissue reconstruction provides the best possibility of achieving superior limb function in soft tissue sarcomas. The aim of this study was to report our experience of free flap microsurgical reconstruction of recently irradiated soft tissue sarcoma defects.
  
  
  METHODS
  A retrospective study of microsurgical outcome in consecutively treated extremity and trunk sarcoma patients undergoing free tissue transfer between 2007 and 2012 was conducted from a prospectively collected database. Outcomes in pre-operatively irradiated patients were compared with non-irradiated patients. Demographic data, operative details, limb salvage rate, post-operative including microsurgical complications, and long-term limb function (Toronto Extremity Salvage score, TESS; Musculoskeletal Tumour Society Rating Scale, MSTS) were recorded and analysed for differences between the two study groups.
  
  
  RESULTS
  Forty-six patients underwent 46 free flaps (pre-irradiated n = 32, non-irradiated n = 14) over the study period. Microvascular complications (intra-operative revision, flap re-exploration, flap loss) were uncommon and similar between the two groups (4/32 and 2/14 respectively, p > 0.05). Recipient site wound healing complications (i.e. not flap related) occurred more frequently in pre-irradiated patients (16 events) compared with the control group (2 events, p = 0.03). There was no significant difference in limb salvage rate, or TESS/MSTS functional outcome scores between the two patient groups.
  
  
  CONCLUSIONS
  Free tissue transfer is safe and effective in patients undergoing surgical resection and reconstruction following neoadjuvant radiotherapy.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Canada. Electronic address: willtownley@hotmail.com.
authors.forename: W A
authors.initials: WA
authors.lastname: Townley
authors.forename: E
authors.initials: E
authors.lastname: Mah
authors.forename: A C
authors.initials: AC
authors.lastname: O'Neill
authors.forename: J S
authors.initials: JS
authors.lastname: Wunder
authors.forename: P C
authors.initials: PC
authors.lastname: Ferguson
authors.forename: T
authors.initials: T
authors.lastname: Zhong
authors.forename: S O P
authors.initials: SO
authors.lastname: Hofer
mesh_terms: D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D058752:Free Tissue Flaps / Q000009:adverse effects; D006085:Graft Survival; D006406:Hematoma / Q000209:etiology; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D012509:Sarcoma / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000628:therapy*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016378:Tissue Transplantation; D034941:Upper Extremity; D014945:Wound Healing / Q000528:radiation effects
keywords: Free flap reconstruction; Pre-operative radiation; Sarcoma