Strategy of Limb Salvage Surgery Using Free Flap for Malignant Tumors of the Extremities

Abstract

Free flap transfer is a useful option for extensive tissue defects after resection of malignant bones and soft tissue tumors of the extremities. Limb salvage using reconstructive microsurgery is important to retain bone stability, joint mobility and coverage of skin. This paper describes a novel reconstruction strategy for such patients. From December 2002 to September 2009, we performed 25 limb salvage operations (upper arm 4 cases, forearm 5 cases, hand 1 case, thigh 6 cases, leg 4 cases, and foot 5 cases) using a novel free flap transfer strategy. When the forearm, hand or foot are affected, it is important to cover such defects with flexible and thin skin. We usually used free anterolateral thigh flaps to repair such defects following wide soft tissue resection. In the upper arm, a free vascularized fibula graft was transferred after resection of the humerus. Around the knee joint, it is advantageous to use a free latissimus dorsi musculocutaneous flap to salvage the knee joint for use with a prosthesis. In cases where the thigh and leg were affected, we used a combination method of heat-treated bone with a free vascularized fibula graft after resection of the femoral or tibial bone.