Enrico Martin

198 Chapter 8 reconstruction after STS resection was described in two studies. 40,41 Gaps of 11-19 cm were reconstructed using peroneal nerves or (vascularized) sural nerves. Both studies combined, more than half of all patients regained protective sensation of the foot sole, but all patients regained some protective sensation in any part of the foot at least one year postoperatively. 40,41 Also, while motor function of the lower leg commonly sustained, knee flexion was often unharmed. In one study, only two patients regained M3-4 dorsiflexion and plantar flexion. 40 Lower leg Functional deficits of the lower leg were reconstructed in four studies describing 10 patients. The anterior compartment of the lower leg mainly provides foot and hallux dorsiflexion and has been reconstructed in seven patients. Both free flaps and tendon transfers were performed. Two studies described a free gracilis transfer resulting in good muscle power (M3-5), and excellent MSTS scores (90-100%). 31,33 Composite ALTs also resulted in good results in one study. 34 A tendon transfer of the tibialis posterior to the extensor digitorum longus and peroneus tertius showed that the foot could remain in neutral position, but dorsiflexion beyond that point was minimal. 42 The posterior compartment’s primary function is plantar flexion. One study describes reconstructions of this compartment using either a free LD, gracilis or parascapular flap and sural nerve. 31 These reconstructions generally provided good motor function (M3-5) and high MSTS score (83.3-100%). Surgical complications A total of 31 patients (23.8%) had postoperative complications. Most of these complications (67.7%) were wound-related, such as superficial infections, wound dehiscence, and seroma. Other complications that occurred were lymph edema (n = 5), venous thrombosis (n = 2), fistula (n = 1), hematoma (n = 1), and femoral fracture (n = 1). Most complications (51.6%) were reported by a single study using different biceps femoris transfer for the restoration of knee extension. 39 Overall, flap failure occurred in two patients. 31,37 One patient had a pedicled LD for reconstruction of arm flexion which was replaced with a free gracilis flap after which an M4 muscle grade was obtained. 31 The other patient ended up with poor functional outcomes. 37 Tendon rupture after reconstruction of the hand occurred in one patient as well, which also resulted in a poor MSTS score. 13 Both patients did not receive radiotherapy or chemotherapy in any modality, but do show that failed reconstructions give poor functional outcomes. Discussion Functional reconstructions in extremity STS are uncommon, yet good muscle grades and high functional outcome scores can be expected when performed even if radiotherapy and chemotherapy are used. Poor outcomes are seen after flap failure,