Enrico Martin

191 Functional reconstructions in extremity STS relatively high incidence at a younger age, and treatment options are slowly improving, more STS patients will become long-term survivors, 30 resulting in an increased amount of patients with lifelong disabilities. The purpose of this review is to summarize current literature on functional reconstructions used in extremity STS and assess their feasibility and outcomes in light of multimodal treatment. This may help sarcoma teams to improve selection of future candidates for such reconstructions before initial treatment. Methods Literature search A systematic search was performed in both PubMed and Embase databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, in order to identify all potentially relevant articles as of July 2018. The search string was built with the help of a professional librarian using search terms related to “soft tissue sarcoma” and “functional reconstruction”. The exact search syntaxes for PubMed and Embase are shown in Supplementary Table 1 . Studies were included that evaluated outcomes of functional reconstructions after soft tissue sarcoma resection. Only free functioning muscle transfers, tendon reconstruction using transfers or allografts, or any nerve reconstruction were considered a functional reconstruction. Replantation of tendons or muscles after tumor excision was not regarded as such. Exclusion criteria included lack of full text, outcomes not stratified for soft tissue sarcomas, case reports, no use of functional outcome measures, no human studies, and languages other than English, Dutch, French, or German. The initial review was conducted by two independent authors (E.M. and M.J.D.). Disagreements were solved through discussion, in which one additional author was involved (J.H.C.). Data extraction and synthesis All data was extracted at an individual patient level and included tumor grade (high/low), tumor site, treatment with radiotherapy or chemotherapy, reconstruction(s) performed, oncologic (survival, local recurrence, metastasis) and functional outcomes, and duration of follow-up. Patients with bone sarcomas or non-extremity sites were excluded from qualitative synthesis, as well as patients with incomplete outcome data. Patients were also excluded in case of soft tissue coverage only, or in case individual patient data in tables and article text did not clarify if functional reconstruction was performed. Results were summarized and stratified per anatomical site: shoulder, upper arm, forearm, hand/wrist, upper leg, and lower leg. In each study the mean of each functional outcome was calculated per muscle group. 8