Enrico Martin

268 Chapter 11 Surgeons should be encouraged to incorporate functional reconstructions as part of their surgical treatment plan as it improves quality of life. Table 5 summarizes general motor and sensory deficits that could be anticipated when resecting major nerves and general reconstructive options to restore these functions. Altogether, when major limb or hand function is lost due to nerve or musculotendinous resection, attempts to reconstruct motor function should be considered. Whenever loss of critical sensation takes place, attempts can be made at restoring sensation with the use of nerve grafting. The reconstruction of sciatic nerve defects have long been topic of debate. While it used to be a reason for amputation in the past, nowadays it is not. 29 Sciatic nerve defects tend to be large with long distance to their target muscles which is why many discourage reconstructing the defect. However, studies in STS specifically showed that the majority of patients are likely to recover at least protective sensation of the foot and is why some advocate its reconstruction even though motor function is rarely restored. 30–32 Additionally, the reconstruction of nerves may reduce neuropathic pain. 33 Combining oncological treatment and reconstructions The exact effect of multimodal therapy on outcomes of functional reconstructions has not been studied extensively. But to date, there has not been an indication of its use precluding successful results. 13,14 Even nerve regeneration does not seem significantly affected by the use of radiotherapy or chemotherapy in this study or other series. These findings are supported by preclinical studies in mice. 34–36 Ideal timing of reconstruction also remains controversial. Obtaining tumor-free margins may however be crucial not only for oncological outcomes, but also diminishing the need for additional resections after reconstruction. Some surgeons emphasize the need for fresh frozen coupes preoperatively or even resecting more of the originating nerve as skip lesions may be present. 2,25,37,38 Whenever adequate margins have been obtained, early reconstructions show superior results over delayed reconstructions. 39–41 Early reconstructions are generally less complex as tissue fibrosis is less extensive, which ameliorates nerve and vessel identification, in turn decreasing possible complications. 39–41 Rehabilitation can also start early, improving functional outcomes. 39–41