Enrico Martin

245 Current attitudes towards function preservation FFMT Nerve reconstruction Nerve transfer Tendon transfer 0% 25% 50% 75% 100% Reconstruction possibilities in MPNST A A sick nerve General poor prognosis Non−extremity site Radiotherapy Slow nerve regeneration Slow rehabilitation 0% 25% 50% 75% 100% Surgical Oncology Neurosurgery Plastic Surgery Other Specialties Relative contraindications for reconstruction B Figure 5 Functional reconstructions. A) Percentage of respondents per subspecialty considering type of reconstruction as an option in MPNST patients, FFMT = free functioning muscle transfer B) Percentage of respondents per subspecialty considering a factor as relative contraindication for functional reconstruction; p-values: * = <0.05, ** = <0.01, *** = <0.001. Functional reconstructions in MPNST Despite the fact that oncological treatment should generally be prioritized in the treatment of any MPNST, early considerations on the preservation of function preservation may benefit patients, especially in the era of limb salvage treatment. Fortunately, not every MPNST will need functional reconstructions as not all MPNSTs arise in major nerves or require the resection of adjacent nerves, tendons, or large muscle bellies. This is reflected in a study reporting a rate of 30% motor deficits after resection of MPNSTs. 16 Fortunately, studies have shown that microscopically positive resection margins do not significantly decrease overall survival in MPNSTs. 4–6 For MPNSTs arising in the brachial and sacral plexus this implies that when adjacent nerve bundles that are not completely encased by the tumor epineural dissection and postoperative radiotherapy may suffice. 23 Reconstructive surgeons are generally equipped with several options for functional reconstructions, yet some do not consider all options suitable in MPNST patients. The selection of the reconstruction is patient- and tumor-site specific, but when large muscle resections are required FFMTs need to be considered, while more distal defects may be restored with the use of tendon transfers. 17,24 Nerve reconstructions are rarely performed in any STS and only few cases have been described in the literature, yet may result in good outcomes. 19 Nerve reconstructions are also crucial for restoring sensation. Although the reconstruction of the sciatic nerve is controversial, protective sensation of the foot 10