Free Gracilis Flap for Anatomic Reconstruction after Limb-sparing Sarcoma Resection

Introduction: Limb-sparing surgery is considered as first choice in most patients with soft tissue sarcomas of the extremities. 5-year survival rates after limb soft tissue sarcoma resection have been promising in many specalised interdisciplinary centres. Quality of life as well as extremity function have thus become an integral aspect of the surgical management of soft tissue sarcomas of the extremities. Objective: We herein report on our experience in the anatomic reconstruction of the extremities following limb-sparing soft tissue sarcoma resection using microvascular gracilis muscle flap and skin grafts. Patients and Methods: Between 2012 and 2014 an anatomic reconstruction of the hand and foot using gracilis muscle flaps following limb-sparing sarcoma resection (leiomyosarcoma N = 2, myxofibrosarcoma N = 2, clear cell sarcoma N = 1, myxoinflammatory fibroblastic sarcoma N = 1, granular cell tumour N = 1, pleomorphic sarcoma N = 1) was performed in N = 8 patients (4 females, 4 males), average age: 44 years (23-76 years), average follow-up time 444 days (98-820). Results: In all patients successful defect coverage with unimpaired wound healing was achieved (adjunctive radiotherapy n = 4). The tendon of the harvested gracilis muscle was used for anatomic reconstruction of consequently resected essential anatomic structures (extensor retinaculum n = 1, flexor/extensor tendons n = 4, extensor expansion n = 2, tendon reinsertion n = 1, proximal interphalangeal joint collateral ligament n = 4, dorsal metatarsal ligament n = 1). During follow-up neither local recurrence nor metastasis was observed. Conclusion: Reconstruction of multidirectional stability as well as restoring biomechanics and kinetics of the hand and foot should be considered during defect coverage and dead space obliteration management after sarcoma resection of the extremities. For reasons of sound options in anatomic extremity reconstruction with minimal donor site morbidity, the gracilis muscle flap excels in the field of limb-sparing sarcoma resection.