Reconstructive approaches in soft tissue sarcoma.

Abstract

Plastic surgical techniques continue to evolve to deal with problem wounds following soft tissue sarcoma resection. Important advances in how tissue is transferred have allowed most wounds to be closed following extirpation; the emphasis is now placed on refining these transfers while minimizing donor site injury. Reconstructive microsurgery has emerged as a frequently preferred way to resurface wounds after sarcoma resection, particularly in patients who have received radiotherapy or previous surgery. Free flaps provide well-vascularized tissue to fill dead space, cover exposed vital structures, and provide structural support and contour. These procedures demonstrate a high success rate of over 90% and often can ensure a healed wound in a single-stage operation. Creative use of the versatile rectus abdominis or latissimus dorsi myocutaneous flaps can reconstruct the majority of breast, extremity, and head and neck soft tissue defects. Endoscopic harvest of muscle flaps has minimized donor morbidity and scarring. The use of "fillet flaps" is an important concept that spares a patient donor site. Composite free flaps, including bone, are routinely used to rebuild the mandible or other bony structures. The future holds great promise for sarcoma reconstruction because tissue engineering is rapidly closing in on techniques that can duplicate tissues in the laboratory for ultimate use in reconstruction, thus sparing the donor site from disease.