Reconstruction of quadriceps function with composite free tissue transfers following sarcoma resection

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Abstract
BACKGROUND AND OBJECTIVES Wide margin resection of a soft tissue sarcoma (STS) may require extensive removal of quadriceps muscle with or without the knee extensor mechanism. The objective of this study is to present present the use of a combined functional muscle transfer and soft tissue coverage through the use of chimeric anterolateral thigh flaps.METHODS: Patients were retrospectively reviewed who underwent deep STS resection of the anterior compartment of the thigh with functional reconstruction of knee extension using a contralateral free anterolateral thigh (ALT) flap.RESULTS: Three patients with an average age 53.6 years (range: 33‐66) were included. Average follow‐up was 82 weeks (76‐92 months). Full active extension was regained in 66% of patients with all patients regaining active extensor capabilities beyond 100°. The mean Knee Society Score was 83.3 (range; 76‐92) and Musculoskeletal Tumor Society Score 21.6 (range; 19‐21). Isometric knee extensor strength exceeded 4+/5 in all patients.CONCLUSION: Following soft tissue sarcoma resections of the lower extremity, chimeric anterolateral thigh flaps for restoration of knee extension can provide significant improvements in the potential for ambulation and regaining quadriceps function.

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