Review Article

Upper extremity sarcoma: impact of current practice guidelines and controversies on reconstructive approaches

¹ Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, CA 92103-8890, USA
² Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, 67071 Ludwigshafen, Germany , the affiliated Department of ptastic surgery of the University of Heidelberg, Germany

*Corresponding author: mdobke@ucsd.edu

Received: 31 August 2016
Accepted: 1 January 2017

Abstract

The goals of sarcoma management include both a cure and the functional preservation of involved tissues and adjacent critical structures with common opinions favoring immediate reconstruction. The question arises whether these goals are contradictory. This paper discusses the question based on the experience of 28 patients with different types of extremity sarcoma, with 24 surgically treated by the University of California San Diego (UCSD) orthopedic and plastic surgery team (2011–2016) and the collection of evidence from published practice guidelines, reviews, case studies, and clinical trials. Included are the impact of limb-sparing and functional reconstructive concepts, efforts regarding the adequacy of surgical margins, and the rationale of immediate versus delayed reconstructive approaches, and the disease-free status of sarcoma management.