Concomitant upper extremity soft tissue sarcoma limb-sparing resection and functional reconstruction: assessment of outcomes and costs of surgery.
BACKGROUND
The purpose of this study is to investigate functional outcomes and cost impacts of immediate functional reconstruction performed in conjunction with limb-sparing resection of upper extremity soft tissue sarcomas.


METHODS
Patients undergoing simultaneous limb-sparing upper extremity soft tissue sarcoma resection and functional reconstruction between December 1998 and March 2004 were retrospectively identified, their medical records reviewed, and costs of surgery analyzed. Functional outcomes and patient satisfaction were assessed via patient surveys and the Toronto Extremity Salvage Score (TESS).


RESULTS
Thirteen patients met the inclusion criteria. Average follow-up was 43.3 months. Reconstructions included rotational innervated muscle flaps (n = 6), free innervated myocutaneous flaps (n = 1), and tendon transfers or grafts (n = 6). Overall survival was 85 % (n = 11) and disease-free survival was 77 % (n = 10). Average total cost of surgery was $26,655. Patients undergoing reconstruction for hand and forearm sarcomas had significantly higher total costs of surgery than those undergoing reconstruction for elbow and upper arm sarcomas. Survey response rate was 91 % (n = 10). Average TESS score was 76. Of the patients who worked preoperatively, 88 % returned to work postoperatively, and all patients who returned to work currently use their affected limb at work.


CONCLUSIONS
Patients undergoing immediate functional reconstruction for upper extremity soft tissue sarcoma resection achieved very good to excellent functional outcomes with quick recovery times and a high return-to-work rate following immediate functional reconstruction, thereby minimizing surgical cost impacts. Immediate functional reconstruction in the same surgical setting is thus a viable strategy following upper extremity soft tissue sarcoma resection.
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA.
Gerhard S
GS
Mundinger
Division of Plastic Surgery, University of Washington Medical Center, Seattle, WA USA.
Roni B
RB
Prucz
Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA.
Frank J
FJ
Frassica
Division of Hand Surgery, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St. JHOC 5243, Baltimore, MD 21287 USA.
E Gene
EG
Deune
Cost analysis; Functional reconstruction; Sarcoma; Upper extremity