title: Reconstruction after musculoskeletal sarcomas: how to avoid a surgical trap.
abstract: BACKGROUND
  Musculoskeletal sarcomas comprise 1% of all malignancies in adults. Unfortunately, sometimes they are addressed in non-appropriate way requiring a more invasive procedure to achieve radical surgery at a later date. Due to incomplete predictability of their extension, scheduled reconstruction cannot be performed at times, forcing plans to change or clogging up immediate reconstruction. In this paper, the authors provide an insight in the treatment of musculoskeletal sarcomas, particularly focusing on the preoperative planning of reconstructive strategies, which is crucial in order to prevent unpleasant surprises during reconstruction.
  
  
  METHODS
  Fifty-six consecutive patients requiring reconstructive procedures following the extirpation of tumors were recruited. All data collected during the diagnostic phase were analyzed collectively during a multi-disciplinary meeting where the surgical procedure was planned. A score system was created and results were then classified into "excellent", "good", "sufficient" and "poor".
  
  
  RESULTS
  After a minimum follow up of 12 months, we recorded the following results: excellent in 10 patients (17.9%), good in 28 patients (50%), sufficient in 12 cases (21.4%) and poor in 6 cases (10.7%).
  
  
  CONCLUSIONS
  The improvement of treatment and the long-lasting survival in musculoskeletal sarcoma have shifted the goal of therapeutic protocol to obtaining radical tumor removal and maximum functional restoration. When facing unpredictable extension of the resections, reconstruction may be a challenging or even impossible task to fulfil. Only meticulous preoperative planning can prevent surgeons from falling into all sorts of surgical traps following wide resections.
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - Regina Elena National Cancer Institute, Rome, Italy - zoccali.giovanni@virgilio.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zoccali
authors.affiliation: Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Costantini
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Ernesto M
authors.initials: EM
authors.lastname: Buccheri
authors.affiliation: Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Biagini
authors.affiliation: Department of Plastic and Reconstructive Surgery, IFO - Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Roy
authors.initials: R
authors.lastname: DE Vita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology / Q000628:therapy; D001859:Bone Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D005121:Extremities / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D051677:Histiocytoma, Malignant Fibrous / Q000534:rehabilitation / Q000601:surgery; D006801:Humans; D023821:Limb Salvage / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D009208:Myoepithelioma / Q000534:rehabilitation / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000534:rehabilitation / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000523:psychology; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D012509:Sarcoma / Q000534:rehabilitation / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult