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Marsden et al. Plast Aesthet Res 2019;6:24 Plastic and
DOI: 10.20517/2347-9264.2019.14 Aesthetic Research

Review Open Access

Advances in functional limb reconstruction in the
irradiated setting

Nicholas Marsden, Damien Grinsell

Department of Plastic Surgery, St Vincent’s Hospital, Melbourne 3065, Australia.
Correspondence to: Dr. Damien Grinsell, Department of Plastic Surgery, St Vincent’s Hospital, 41 Victoria Parade, Fitzroy,
Melbourne, Australia. E-mail: damiengrinsell@gmail.com

How to cite this article: Marsden N, Grinsell D. Advances in functional limb reconstruction in the irradiated setting. Plast Aesthet
Res 2019;6:24. http://dx.doi.org/10.20517/2347-9264.2019.14

Received: 21 Aug 2019 First Decision: 31 Oct 2019 Revised: 6 Nov 2019 Accepted: 15 Nov 2019 Published: 29 Nov 2019
Science Editor: Matthew L. Iorio Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract
The management of extremity soft tissue sarcoma is constantly evolving, and, in recent decades, limb salvage
has been the main goal. More commonly, this is being achieved with a combination of neo-adjuvant radiotherapy,
followed by wide excision and soft tissue reconstruction in the form of vascularised soft tissue transfer. Although limb
salvage is now readily achievable, the resultant functional disabilities following excision of major musculotendinous
and neurovascular structures can be life changing. In recent years, there has been a move towards functional limb
reconstruction in the form of free functioning muscle transfer. This paper reviews the advances in functional limb
reconstruction in the setting of preoperative radiation and reports our experience in this challenging reconstructive
field.

Keywords: Sarcoma, radiation, functional limb reconstruction, free functioning muscle transfer, nerve transfer

INTRODUCTION
Soft tissue sarcomas (STS) are a rare group of mesenchymal tumours commonly affecting the extremities.
[1]
Historically, extremity STS patients were commonly treated by amputation, with rates of around 40%-50% .
[2]
However, in the 1980s, “limb-preserving surgery” became the mainstay of treatment after Rosenberg et al.
demonstrated equivalent five-year survival rates with a combination of wide excision and radiotherapy
compared to amputation. Limb preserving surgery in combination with radiotherapy for high-risk
[3-5]
extremity STS has been shown to yield superior local control over excision alone . There remains a debate

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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