Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Plastic Surgery Reconstruction of Distal Leg Sarcomas: Functional and Oncologic Outcomes
Carolyn J. Vaughn, MD, Merisa L. Piper, MD, Rosanna Wustrack, MD, Hani Sbitany, MD.
University of California San Francisco, San Francisco, CA, USA.

PURPOSE:
Limb salvage surgery has become the accepted standard for treatment of bone and soft tissue tumors of the extremities. While previous studies have shown acceptable oncologic and functional outcomes, studies are mostly limited to case reports and small retrospective series. The involvement of plastic surgery for reconstruction of these defects may allow for a wider resection, thereby improving local-regional recurrence rates. By replacing the soft tissue and bony defects, these patients may have improved functional outcomes. We sought to review patients with distal lower extremity tumors treated with limb salvage surgery at our institution to determine if plastic surgery reconstruction affected local recurrence rates or functional outcomes.
METHODS:
We queried the cancer registry database for patients who underwent surgery at our institution for treatment of bone and soft tissue tumors of the distal lower extremity between 1993 and 2014. A retrospective chart review of these patients was then performed. Patients were included if their tumors involved the distal leg, ankle, or foot. Patients who had a primary amputation as treatment were excluded (n=10). We reviewed for involvement of plastic surgery for reconstruction, including skin graft, local flap, free flap, or vascularized bone graft. Patients who had plastic surgery reconstruction were compared to those who did not for postoperative complications, local recurrence, need for reoperation or secondary amputation, and functional status (walking, support, and pain adapted from MSTS score).
RESULTS:
Fifty-one patients underwent limb salvage surgery. Average age at diagnosis was 42 years (range 2-90 years). Median follow up after surgery was 32 months. Twenty-six patients had tumors of the distal leg, 5 of the ankle, and 20 of the foot. Twenty patients had plastic surgery reconstruction (10 skin grafts, 1 local rotational flap, 8 free flaps, 1 vascularized bone graft). Three patients went on to have secondary amputation (2 patients who had no plastic surgery reconstruction, 1 patient who had STSG). Average defect size after resection was 89 cm2 in patients who had plastic surgery reconstruction, and 33 cm2 in those who did not. There was no statistically significant difference in rates of reoperation or local recurrence between the two cohorts, but those who had plastic surgery involvement had an increased risk of wound complications (RR= 3.62, p 0.03). There was a trend toward better functional outcomes (walking ability, support, and pain) in the group who underwent plastic surgery reconstruction, but these did not reach statistical significance.
CONCLUSION:
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Limb-salvage surgery provides acceptable oncologic outcomes, and plastic surgery involvement for reconstruction of soft tissue and bony defects may improve functional outcomes for patients with tumors involving the distal lower extremity.


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