Reconstructive surgery as part of the AMORE protocol in the treatment of pediatric head and neck soft tissue sarcoma

For advanced stage residual or recurrent paediatric soft tissue sarcomas in the head and neck area, the AMORE protocol was developed in our hospital. It consists of Ablative surgery, afterloading brachytherapy, using a MOulage technique and REconstructive surgery in 1 week. The reconstructive surgical component of this treatment regimen was reviewed. Between January 1993 and November 1999, 18 children with soft tissue sarcomas in the head and neck area were treated according to the AMORE protocol. The median follow-up was 31.5 months (range 2 months to 6.5 years). For reconstruction, a free vascularized muscle transfer was performed in 12 patients and a pedicled muscle transposition in six patients. The surgical reconstruction was successful in all but one patient and in 16 of 18 patients, healing was uneventful. Since the introduction of this multidisciplinary approach in the treatment of paediatric soft tissue sarcomas in the head and neck region, the results have been promising. The immediate reconstruction of an irradiated, contaminated wound bed with uncompromised, well-vascularized muscle tissue has, in general, resulted in excellent wound healing. The treatment was undertaken in a limited amount of time and resulted in an acceptable morbidity.