Lower extremity salvage in cancer patients using free tissue transfer

Free tissue transfer (FTT) is a recent addition to the multimodal approach of limb-sparing procedures in patients with sarcoma and other tumors of the lower extremity. We present a prospective review of 14 men and 11 women (mean age, 50 years) with lower extremity tumor undergoing FTT for limb salvage. Follow-up ranged from 6 weeks to 30 months (mean, 11 months). Seventeen procedures were peformed on the left and 9 on the right lower limb. Seventeen patients had immediate reconstruction of their soft tissue defect after surgical extirpation of tumor, while 8 patients underwent delayed repair of irradiated wounds resulting from previous treatment of sarcoma. One delayed reconstruction was performed after a failure of an immediate FTT. Defects occurred in: plantar foot - 4, leg - 7, knee 3, and thigh - 11. Average defect size: plantar foot 62.9 cm², leg 128.9 cm², knee 252.7 cm², and thigh 278.8 cm². Preoperative radiation therapy was received by 35% (6/17) of the immediate reconstruction group (mean dose, 50 Gy) and 100% of the delayed reconstruction group (mean dose, 62.3 Gy). The overall complication rate was 50%; the complication rates were 41% and 67% (p = 0.21) in the immediate and delayed groups, respectively. Flap failure occurred in 12% (3/26) of procedures; two FTTs failed in the same patient. Limb salvage using FTT was successful in 92% of patients despite complications; the overall ambulatory rate after reconstruction was also 92%. We conclude that FTT is a reliable method of extending the limits of limb salvage in a group of patients at high risk for amputation.