Soft Tissue Reconstruction After Bone Sarcoma Resection

Chapter Overview

The successful outcome of bony tumor resection followed by prosthetic reconstruction can often be improved by the addition of appropriate soft tissue reconstruction using muscle or skin flaps of various types. Such flaps are particularly useful for areas likely to encounter wound-healing problems. The benefits of flap reconstruction are seen particularly in high-risk areas such as the ankle and foot, the tibial and knee region, the distal forearm and hand, the elbow, and the shoulder. The most distal parts of the extremities usually require free-flap reconstruction because of a lack of sufficient local soft tissue; however, more proximal areas can be reconstructed with a variety of local pedicled flaps, simplifying the procedures. Fillet flaps can also be used to aid in soft tissue closure if the extremity cannot be salvaged. Flap selection for specific areas is based on the size of the defect, type of coverage required (i.e., skin versus muscle), patient position, tissue availability, and surgeon preference. Proper preoperative planning and coordination between the plastic and orthopedic surgeons are critical.