PURPOSE: Soft tissue sarcomas (STS) in the lower extremity requiring free tissue transfer (FTT) involve unique surgical challenges. Healthy tissue integration with free flaps appears to offer improved healing. This study assesses FTT outcomes for STS reconstruction in the lower extremity.
METHODS: Retrospective analysis of patients undergoing FTT for STS reconstruction at MD Anderson from 2016-2021 was conducted. Statistical tools included cross tabulation and chi square analysis.
RESULTS: 40/302 patients underwent FTT. 15.0% had diabetes, 42.5% hypertension, 15.0% coronary artery disease, and 5.0% pulmonary disease. None smoked; 2.5% had renal disease. Half had a comorbidity. 87.5% received preoperative radiation. The overall complication rate was lower for the free flap group (12.5% vs. 42%, p<0.001). Specific complications, including surgical site infection (2.5% vs. 16%, p=0.023), seroma (0% vs. 13.7%, p=0.01), and incisional dehiscence (5% vs. 20.6%, p=0.02), were more prevalent in the non-free flap group. Dressing changes >6 weeks were also higher in the non-free flap group (5% vs. 19.5%, p=0.02). Other complications, like reoperations and graft loss, were not significantly different.
CONCLUSION: FTT leads to fewer overall complications in lower extremity sarcoma reconstruction. Higher complication rate in the non-free flap group may highlight challenges from radiation therapy or wide defect closure. The displayed healing advantages underscore free flap reconstruction reliability. Surgeons should employ FTT to diminish the frequency of healing complications observed with simpler techniques.
