Enrico Martin

193 Functional reconstructions in extremity STS tendon reconstructions in 58.2%, and nerve reconstructions in 12.7%. Most studies included patients with high grade sarcomas, which resulted in 60.3% (range: 0-100%) of all cases using radiotherapy, and 49.4% (range: 0-70%) chemotherapy. A wide variety of functional outcome measures were used, of which the Musculoskeletal Tumor Society scoring system (MSTS) and Medical Research Council muscle grade (MRC) were most commonly used. Shoulder and upper arm Four different studies included reconstructions of shoulder and upper arm functions in 13 patients ( Table 2 ). The deltoid muscle was most commonly reconstructed with a pedicled innervated latissimus dorsi flap (LD), but a free functioning tensor fascia lata (TFL) flap was also described. Both operations yielded good muscle grades (M4), good range of motion in shoulder abduction, and high MSTS scores (both >90%). Loss of elbow flexion was commonly reconstructed with the use of a pedicled LD, 13,31 but a free functioning gracilis transfer has also been performed. 31 Although relatively low MSTS scores were seen on average in one study (63.3%), patients did regain M4 elbow flexion. 31 Toronto Extremity Salvage Scores (TESS) were however excellent in another study (98.7%). 13 The latter study also presented one patient with loss of elbow extension reconstructed with the use of a pedicled LD as well yielding good results (TESS = 100%). 13 All studies that evaluated muscle grade, showed that all patients regained at least M3 muscle power, regardless of multimodal therapy. Forearm Functional reconstructions in forearm compartments are described in four studies in nine patients. Loss of function in the flexor compartment was either reconstructed by tendon transfers 13 or a free LD flap. 32 Lost extensor compartment function, leading to either loss of wrist extension, finger extension, or a combination, was reconstructed with a free gracilis flap, 32,33 a free LD flap, 32 or a composite anterolateral thigh flap (ALT). 34 A composite ALT may contain part of the vastus lateralis, TFL, and iliotibial band. All patients regained reasonable muscle grade (M3-4) and reasonable to excellent MSTS scores (66.7-100%) and TESS (61.3-92.6%). 34 No nerve reconstructions have been described in these studies. 8