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Extended Indications for Functional Limb-Sparing Surgery in Extremity Sarcoma Using Complex Reconstruction

I. Benjamin Paz, MD; Lawrence D. Wagman, MD; Jose J. Terz, MD; Balasubramaniam Chandrasekhar, MD; John A. Lorant, MD; Gary M. Moscarello, MD; Tamara Odom-Maryon, PhD
Arch Surg. 1992;127(11):1278-1281. doi:10.1001/archsurg.1992.01420110020005.
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• From 1980 to 1991, 29 patients underwent complex reconstruction following extremity sarcoma resection. Soft tissue was the site of origin in 15 patients (52%) and bone was the site of origin in 14 patients (48%), with 20 sarcomas (69%) in the lower extremity. Resection consisted of the following procedures: extended anatomical soft-tissue resections (21 patients [72%]), bone resections (18 patients [62%]), and joint resections (14 patients [48%]). Reconstruction involved the following: myocutaneous flaps (20 patients [69%]), joint prosthesis (eight patients [28%]), and bone reconstruction (15 patients [52%]). There was no surgical mortality; one patient required an amputation owing to surgical complications. The site of the first failure was local (four [31 %] of 13 patients), lung (five patients [38%]), others (four patients [31 %]). At a median follow-up of 23 months, 18 patients (62%) had no evidence of disease, 27 (93%) had no local disease, 21 (72%) had good extremity function, three (10%) had major disabilities, and five (17%) underwent amputations. Local control improved when the margin of resection was larger than 10 mm. Disease-free survival was 67% at 3 years. Overall survival was 51% at 5 years. Tumor size was an independent predictor of overall survival. Local recurrence did not affect overall survival.

(Arch Surg. 1992;127:1278-1281)


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