Immediate versus delayed free-tissue transfer salvage of the lower extremity in soft tissue sarcoma patients

Background: Free tissue transfer (FTT) can extend the limits of limb salvage in patients with soft tissue sarcoma (STS), but few data exist on the efficacy and morbidity in this patient population. Methods: We prospectively examined 19 patients who underwent resection of STS and an immediate or a delayed FTT reconstruction between November 1989 and May 1992. Results: There were 11 immediate and eight delayed FTT reconstructions (mean age 52 years). All delayed patients presented with complications resulting from previous STS treatment. Defects involved the leg (n=7), knee (n=2), and thigh (n=10) and had a mean size of 129 cm², 154 cm², and 283 cm², respectively. Preoperative radiatiotherapy had been administered to 74% of patients in the series (mean dose 53 Gy). FTT success rate was 95% (one failure in the delayed group). Limb salvage and postreconstruction ambulatory rates were both 95%. The overall complication rate was 47%, with the trend of a higher rate (63%) in the delayed group compared with the immediate group (36%). The immediate reconstruction group required no additional operative procedures before FTT and had a shorter hospital stay (13 days) compared with that of the delayed reconstruction group (40.6 days). Mean follow-up was 11.9 months (range 2-30). Conclusions: FTT is a reliable and versatile adjunctive treatment for lower extremity salvage of patients with STS. Immediate reconstruction appears to carry a lower complication rate and a faster rehabilitation for the patient.