May 1991

Composite Tissue Transfer in Limb-Salvage Surgery

Author Affiliations

From the Divisions of Surgical Oncology (Drs Krag, Schneider, and Goodnight) and Plastic Surgery (Dr Klein), Department of Surgery, University of California, Davis, Medical Center, Sacramento.

Arch Surg. 1991;126(5):639-641. doi:10.1001/archsurg.1991.01410290117023

• After extensive resection due to extremity sarcoma, the inability to cover the defect for satisfactory healing and limb function has been an indication for amputation rather than limb salvage. We report herein our experience with seven limb-salvage cases in which we closed difficult and complex defects with composite tissue transfers utilizing microvascular techniques. Free-flap transfers were used to cover soft-tissue defects after extensive resection of primary and locally recurrent tumor and to manage radiation-induced complications. The grafts healed well when infected irradiated tissue was covered, and the grafts tolerated postoperative irradiation. Composite tissue transfer also provided soft-tissue coverage around distal joints that would not have been adequately protected with a skin graft. Complications were minimal, and all patients maintained good extremity function. No patient who underwent composite tissue transfer has had a local recurrence. A free-flap composite tissue transfer can extend the indications for limb-salvage surgery and offers an alternative to amputation in selected patients.

(Arch Surg. 1991;126:639-641)