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Immediate Tendon Transfer For Functional Reconstruction Of A Dorsal Forearm Defect After Sarcoma Resection
Ryo Karakawa, MD1; Yoshimatsu Hidehiko, MD2; Tomoyuki Yano, MD, FACS1
1Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; 2Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan

Background In the treatment of sarcoma, the reconstructive surgeon must consider not only limb salvage but also functional reconstruction. We describe functional reconstruction using immediate tendon transfer.
Methods Patients who underwent reconstruction of a dorsal forearm defect after sarcoma resection with immediate tendon transfer between 1997 and 2019 at our hospital were included in this study. Patient demographics, tumor characteristics, surgical characteristics, and functional outcomes were examined. The flexor carpi radialis (FCR), the flexor carpi ulnaris (FCU), and the brachioradialis (BR) were used for restoration of finger extension. The palmaris longus (PL) tendon was used for restoration of thumb extension. Surgical wide resection followed by immediate tendon transfer was performed. After the tendon transfers, the defect was closed with or without a free flap transfer. The arm was immobilized with the wrist extension of 30 degrees, the MP joints in slight flexion, and the thumb in maximum extension and abduction in a volar splint. Active flexion and passive extension exercises were started two weeks postoperatively. Active extension was allowed from three weeks after surgery. (Fig. 1, 2)
Results Nine patients were included in this study. Tendon transfer of the FCR or the FCU to the extensor digitorum communis (EDC), the BR to the EDC, and the PL tendon to the extensor pollicis longus (EPL) was performed in seven, two, and five patients, respectively. Seven patients underwent reconstruction using a free flap. A fibula flap was used in one case, a superficial circumflex iliac artery perforator (SCIP) flap was used in one case, and an anterolateral thigh (ALT) flap was used in five cases. All the flaps were survived. The mean distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MP) joint active extension were 4.4, -6.1, and -11.1 degrees postoperatively. The mean Musculoskeletal Tumor Society (MSTS) score was 86.4 %. Comparing the functional results of the FCR/FCU group with the BR group, the median DIP extension (0 vs. -25 degrees, p = .005), the median PIP extension (0 vs. -27.5 degrees, p = .005), and the mean MP extension (- 2.1 vs. -42.5 degrees, p = .007) were statistically greater in the FCR/FCU group. (Fig. 3, 4)
Conclusion Immediate tendon transfers of the FCR to the EDC and the PL tendon to the EPL can be considered an optimal functional reconstruction of a dorsal forearm defect after sarcoma resection.




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