title: Musculoskeletal sarcomas in the forearm and hand: standard treatment and microsurgical reconstruction for limb salvage.
abstract: Sarcomas in the forearm and hand are very rare, accounting for less than 1% of all upper-limb tumors and clinical outcomes after surgery and adjuvant therapies are uncertain. The forearm and hand present specific challenges due to their unique anatomical structures. There is little soft tissue and each compartment is narrow, such important structures exist in close proximity. Anatomic constraints make it difficult to achieve wide surgical margins. Although sarcomas often metastasize to the lung, the overall survival rate is excellent. Wide marginal resection during initial surgery is the most predictive factor for tumor control. The role of reconstructive surgery following wide excision for sarcoma of the forearm and hand is even more important than elsewhere in the body because excision is likely to cause bone, tendon and nerve defects, leading to severe functional deficits. Multiple options exist for bony and soft tissue reconstruction of the upper limb, with the choice dependent upon tumor type, wound characteristics, surgeon preference and the patients' functional requirements. Success should be measured not just by stable wound coverage but also by preservation of patient's health, limb cosmesis, sensation and function. Careful preoperative planning with consideration of all the possible resected structures should improve patient outcomes.
authors.affiliation: Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan. muramatu@yamaguchi-u.ac.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Muramatsu
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ihara
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshida
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tominaga
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Taguchi
mesh_terms: D005542:Forearm / Q000473:pathology / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage / Q000523:psychology*; D019651:Plastic Surgery Procedures; D012509:Sarcoma / Q000188:drug therapy / Q000523:psychology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Musculoskeletal tumor; forearm; hand; limb salvage; microsurgery; review; tissue transfer