Current strategies for sarcoma reconstruction at the forearm and hand.

Multistructural reconstructive procedures are often required to achieve a sufficient reconstruction of the forearm and/or hand after radical tumor resection. Clear margin (R0) resection is the main therapeutic goal for the treatment of sarcomas. Plastic reconstructive procedures with the possibility of microvascular transplantations play a key role in coverage of complex defects. In our department, 20 patients with soft tissue sarcomas of the hand/forearm were treated between 1995 and 2005. Eleven patients were male, nine female. The average follow-up time was 42 months. The most common tumor type was the myxoid fibrous histiocytoma in 10 cases. Six patients received a free microvascular transplantation to cover the defect after radical resection, local flaps, or primary closure was performed in five cases. Preservation was not possible in nine cases. Ten patients received radiation and four obtained chemotherapy postoperatively (two patients received neoadjuvant chemotherapy). Extremity function, the DASH questionnaire, and patient satisfaction were our examination parameters. Our results show the necessity of plastic-surgical reconstruction of the forearm and hand as an integrative component of modern sarcoma therapy. It can be concluded that plastic-surgical reconstruction of the extremity plays a key role within the multimodal concept of therapy for patients with sarcoma at the forearm and hand.