Soft Tissue Reconstruction of the Hand Following Sarcoma Resection

Author(s): SG Talbot, BJ Mehrara, JJ Disa, AK Wong, A Pusic, PG Cordeiro, EA Athanasian

Source: Plast Reconstr Surg 121: 534-43, 2008.

Summary:

This retrospective review reports a single cancer center’s 9-year experience with soft-tissue coverage and reconstruction following hand sarcoma resection. The authors identified 50 patients with hand sarcoma resection and evaluated for demographics, pathologic findings, location, size, depth, grade, stage, method of resection and reconstruction, adjuvant therapies, complications, and patient outcomes. 

The results indicate the median age was 36 years (range, 1 to 80 years). The most common malignancies were epithelioid sarcoma (n= 9), soft-tissue malignant fibrous histiocytoma (n=8), synovial sarcoma (n=6), and fibrosarcoma (n=4). Flap reconstructions were required in 27 patients. The most common reconstruction method was a finger fillet flap in eight patients, followed by the radial forearm flap in five patients and the gracilis flap and skin grafting in three patients each. A suboptimal biopsy before presentation was strongly predictive of the need for flap reconstruction. Nine patients had complications
(delayed healing or skin necrosis, fracture, nonunion, epidermolysis, and tendon adhesion). No microvascular complications occurred.

The data presented in this article represents a series of heterogeneous bone and soft-tissue sarcomas referred to a highly specialized dedicated cancer center and cannot be interpreted as descriptive for any particular disease entity.  However, the principles highlighted pertain to all surgeons caring for patients with hand sarcomas.  Namely, that the keys to success are early diagnosis, expeditious hand–sparing tumor resection with negative margins, and stable soft-tissue coverage.  The complication rates in this series were relatively low presumably because of the extensive use of a limited number of reconstructive techniques thus underscoring the principle of “knowing your workhorse flaps.”