Enrico Martin

247 Current attitudes towards function preservation the importance of prevention. 36 Interestingly, in a recent systematic review of functional outcomes after nerve reconstructions in extremity STS, none of the patients were reported to have neuropathic pain. 19 A wide variety of surgical techniques are described, most of which rely on guiding the transected nerve to tissue in which to grow. 35,36 To date, no single technique has repeatedly shown to be superior to others. Ideal nerve stump handling will therefore need to be assessed on a case-by-case base, taking the anatomical location and particular nerve in consideration. Novel techniques such as targeted muscle reinnervation have shown promising results, especially in amputees. 37 As observed in our study, this is not yet widely used, but has the most interest among plastic surgeons. In order for surgeons to perform neuroma preventive actions, precarious dissection will aid in identifying neighboring nerves and the nerve from which the MPNST originated. Intraoperative nerve conduction testing may further help discriminate between sensory and motor fascicles as well, which in turn aids in fascicular dissection: motor fascicles can be possibly spared and sensory nerves can be appropriately handled for preventing neuroma formation. However, neuroma preventive measures are not studied in MPNST and sarcoma surgery since oncological outcomes are prioritized in both clinical and research settings. Strengths and limitations This survey does have its methodological inherent limitations. Respondent bias is always present as only physicians who are interested will fill out the survey. Also, as we restricted our distribution to a selected list of surgical societies, selection bias may be present as surgeons that do operate MPNSTs but are not members of these societies were excluded from participation. Additionally, this paper does not assess the effect of volume and surgical discipline on oncological and functional outcome. In general, it has been found that oncological outcome is better when patients are treated in sarcoma centers with ample experience with sarcoma patients. 38 It seems advisable to collaborate between surgical subspecialties, such as surgical oncologists, peripheral nerve surgeons, and reconstructive surgeons to optimize both oncological and functional outcome, especially when motor or mixed nerves are involved. Although current literature is still limited on the use of functional reconstructions and prevention of neuropathic pain in STS, the high rates of postoperative morbidity in MPNSTs are acknowledged and most surgeons agree that restoration of function is warranted. Overall survival of localized disease varies depending on size, location, and grade of the tumor, but combining responses to this survey with the knowledge that localized MPNSTs have a median survival of at least 5 years, the consideration for function preservation seems justifiable. And while there is no specific prognostic tool for MPNSTs specifically, calculators for all STS do exist which could be helpful in the decision making process. 39,40 Future studies should nonetheless be encouraged to evaluate functional outcomes in MPNSTs specifically, in order to elucidate techniques in minimizing morbidity. 10