Soft tissue sarcoma of the upper extremity - A 5-year experience at two institutions emphasizing the role of soft tissue flap reconstruction

BACKGROUND. The objective of this study was to define the impact of soft flap reconstruction on multimodality therapy for patients with soft tissue of the upper extremity. Treatment standards continue to evolve for these patients, and, with multimodality therapy, most of them are candidates for limb-p surgery. Consequently, the role of soft tissue flap reconstruction is expanding. METHODS. A review was conducted of 100 consecutive patients with soft sarcomas of the upper extremity who underwent surgery at several between 1992 and 1997. RESULTS. Seventy-one patients underwent direct closure of defects after resection, and 29 patients required Soft tissue reconstruction with flaps. groups were similar in most respects, except that 52% of the patients who soft tissue reconstruction presented with recurrent disease (P = 0.0004), and of them had tumors measuring > 5 cm in greatest dimension (P = 0.0003). patients who required flap reconstruction had larger skin deficits after tumor resection (140 cm(2)) compared with the patients who had wounds that managed by direct Closure (40 cm(2); P < 0.00001). Margins around the tumors were larger (1.62 cm) when flaps were employed compared with when defects were closed directly (0.87 cm; P 0.0005). However, the number patients with intralesional, marginal, wide, and radical resections was the regardless of wound management. Major complications occurred in 14%. of patients, but none led to death or amputation. The median follow-up was 31 and 66% of patients had no evidence of disease at that time. Rates of recurrence and survival were similar for patients who underwent flap reconstruction compared with patients who underwent direct closure. CONCLUSIONS. Soft tissue flap reconstruction facilitates therapy for patients soft tissue sarcomas of the upper extremity, so that patients with larger tumors undergo resection, limiting complications and limb sacrifice. (C) 2002 American Cancer Society.