Plastic and Reconstructive Surgery, Global Open (Feb 2021)

Function-preserving Surgery for Femoral Sarcoma by “In Situ Preparation” Technique with a Free Flap

  • Kazuhisa Uemura, MD,
  • Seiji Kanno, MD, PhD,
  • Takashi Shimoe, MD, PhD,
  • Fumiyoshi Kojima, MD, PhD,
  • Shinichi Murata, MD, PhD,
  • Hirohisa Kusuhara, MD, PhD,
  • Yoshitaka Wada, MD, PhD,
  • Shinichi Asamura, MD, PhD

DOI
https://doi.org/10.1097/GOX.0000000000003398
Journal volume & issue
Vol. 9, no. 2
p. e3398

Abstract

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Summary:. Resection of soft-tissue sarcomas near important tissues (major blood vessels, nerves, bones) is challenging. “In situ preparation” (ISP) technique enables the function of the affected limb to be maintained by preserving the tissue as much as possible. The technique is based on evaluation of the margin of resection of important tissues near the tumor during surgery. Postoperative fractures are known to frequently occur, however, in cases where bones were preserved and periosteum has been resected by the ISP. We present the case of a 51-year-old woman who required treatment for soft-tissue sarcoma close to the femur. During surgery, femoral periosteum was included in the tumor side and the femur was preserved by the ISP. We covered the femur using a vascularized latissimus dorsi free flap instead of periosteum. The flap survived completely, and 5 years after surgery, there has been no recurrence or postoperative complications and the lower limb is functional. This is the first reported case of successful combined use of the bone ISP and the vascularized latissimus dorsi free flap to preserve the function of the limb affected by femoral sarcoma suspected of bone infiltration.