title: [Reconstruction of Defects after Oncologic Resection and Radiation - Indications for Microsurgical Reconstruction].
abstract: The surgical treatment of soft tissue sarcomas in the extremities frequently requires radiation therapy to achieve local tumour control. However, both adjuvant and neoadjuvant radiation are associated with significant morbidity caused by impaired wound healing, ulcers or osteonecrosis with subsequent fractures. This is due to altered local cell mediator levels, fibrosis occurring simultaneously with decreased cell division rates and diminished vascularity. This article describes a number of local conservative treatment options, all of which have limited success rates. In addition, it describes plastic surgical treatment options for radiation-induced local morbidity. Surgical reconstruction includes the full range of plastic reconstructive techniques. However, less complex options such as random pattern flaps or split thickness skin grafts are often associated with complications. Therefore, a large number of cases require free tissue transfer.
authors.affiliation: BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen.
authors.forename: T
authors.initials: T
authors.lastname: Kremer
authors.affiliation: BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen.
authors.forename: T
authors.initials: T
authors.lastname: Cordts
authors.affiliation: BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen.
authors.forename: C
authors.initials: C
authors.lastname: Hirche
authors.affiliation: BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen.
authors.forename: F
authors.initials: F
authors.lastname: Hernekamp
authors.affiliation: BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen.
authors.forename: C
authors.initials: C
authors.lastname: Radu
authors.affiliation: BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen.
authors.forename: U
authors.initials: U
authors.lastname: Kneser
mesh_terms: D003131:Combined Modality Therapy; D005121:Extremities / Q000528:radiation effects* / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D008866:Microsurgery / Q000379:methods*; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D010025:Osteoradionecrosis / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D011379:Prognosis; D011832:Radiation Injuries / Q000601:surgery*; D011855:Radiodermatitis / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D014945:Wound Healing / Q000528:radiation effects