Abstract
The purpose of this study is to present a series of soft tissue sarcomas requiring complex vascular reconstructions, and to describe their management and outcomes.
Soft tissue sarcomas are rare mesodermal malignancies accounting for approximately 1% of all cancers diagnosed annually. Sarcomas involving the pelvis and extremities are of particular interest to the orthopaedic surgeon. Tumours that encase and invade large calibre vascular structures present a major surgical challenge in terms of safety of excision with acceptability of surgical margins. Technical advances in the fields of both orthopaedic and vascular surgery have resulted in a trend towards limb salvage with vascular reconstruction in preference to amputation. Limb-salvage surgery is now feasible due to the variety of reconstructive options available to the surgeon. Nevertheless, surgery with concomitant vascular reconstruction is associated with higher rates of complications including infection and amputation. We present a case series of soft tissue sarcomas with vascular compromise, requiring resection and vascular reconstruction. We treated four patients (n = 4, three females, and one male) with soft tissue masses, which were found to involve local vascular structures. Histology revealed leiomyosarcoma (n = 2) and alveolar soft part sarcomas (n = 2). Both synthetic graft and autogenous graft (long saphenous vein) techniques were utilised. Arterial reconstruction was undertaken in all cases. Venous reconstruction was performed in one case. One patient required graft thrombectomy at one month post-operatively for thrombosis.
We present a series of complex tumour cases with concomitant vascular reconstructions drawn from our institution's experience as a national tertiary referral sarcoma service.
