Enrico Martin

294 Part II Functional outcomes and possibilities for treatment in MPNST In Part II, we explore options and outcomes of reconstructions to ameliorate postoperative functional status in extremity sarcomas and MPNST patients. To date, this has had remarkably less attention compared to oncological treatment and outcomes. Traditionally, the role of plastic surgeons has only been for soft tissue coverage, but functional reconstructions are increasingly being used in trauma cases. These may potentially play a similar role in sarcoma surgery. Chapter 8 Functional Reconstructions in Extremity STS Functional reconstructions include the reconstruction of nerves and tendons or replace lost function with free functioning muscle transfers. As extremity STS have a varying prognosis and commonly require additional therapies such as radiotherapy and chemotherapy, the feasibility and outcomes of functional reconstructions in these patients are not well known. For this purpose, we systematically reviewed all case series available on such reconstructions in extremity STS. A total of 14 different studies, describing 134 patients, were included. Tendon reconstructions (58.2%) and free functioning muscle transfers (41.0%) were most commonly used. Overall, we observed that most reconstructions adequately restored function. Most cases received additional therapy including radiotherapy (60.3%) and/or chemotherapy (49.4%). The use of such multimodal therapies did not preclude successful outcomes. The exact choice of reconstruction varies per patient and lesion as several factors play a role in determining an optimal strategy. Chapter 9 Nerve Reconstructions in Extremity STS Nerve reconstructions provide the opportunity to restore sensation and reduce the risk of neuropathic pain besides the restoration of motor function. Nevertheless, as we observed in Chapter 8 these are rarely performed after resection of extremity STS. Nerves regenerate slowly which may be an additional factor precluding surgeons to use such reconstructions. We therefore reviewed all cases in literature on the use of nerve reconstructions after the resection of extremity STS. We found 19 studies describing outcomes of 26 patients. The majority of nerve reconstructions were performed in upper extremity cases in contrast to functional reconstructions in general. Nerve grafting procedures were most commonly employed. Most patients recovered at least some motor function and sensation. Successful reconstructions were more common in upper extremity reconstructions. We did not find a negative influence of multimodal therapy on functional outcomes of reconstructions. Chapter 10 Current Attitudes towards Function Preservation Because functional reconstructions are rarely performed and several surgical subspecialties operate or encounter MPNSTs, more could be learned on their attitudes towards integrating such reconstructions. In the same survey presented