Case report: Hybrid reconstruction of quadriceps function after sarcoma resection using a reinnervated free flap and tendon transfer

B Hoteit; A Delgove; D Adam; M Fau; A Michot

doi:10.1016/j.anplas.2024.08.006

Case report: Hybrid reconstruction of quadriceps function after sarcoma resection using a reinnervated free flap and tendon transfer

Ann Chir Plast Esthet. 2024 Aug 27:S0294-1260(24)00140-7. doi: 10.1016/j.anplas.2024.08.006. Online ahead of print.

Authors

B Hoteit¹, A Delgove², D Adam², M Fau³, A Michot³

Affiliations

¹ Plastic, Reconstructive and Aesthetic Surgery Department, Francois-Xavier-Michelet Center, University Hospital Center of Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France. Electronic address: basselhoteit4@gmail.com.
² Plastic, Reconstructive and Aesthetic Surgery Department, Francois-Xavier-Michelet Center, University Hospital Center of Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
³ Oncologic and Reconstructive Surgery Department, Bergonié Institute, 229, cours de l'Argonne, 33076 Bordeaux, France.

PMID: 39198046
DOI: 10.1016/j.anplas.2024.08.006

Abstract

We describe a case of a leiomyosarcoma of the thigh, the resection of all the anterior muscular compartment, and the reanimation of knee extension, using a latissimus dorsi (LD) free flap and tendon transfer. Surgical technique and postoperative care management are described. Functional results, neuropathic pain, and range of motion (ROM) were assessed at 3 months and 12 months after discharge. A complete excision (R0) was carried out and rapid wound healing was obtained despite developing a seroma infection. The patient was able to walk without technical support nor limping at 3 months post-surgery. The patient was still in remission at 12 months follow-up, with Medical Research Council (MRC) scale assessed at 4/5 and ROM rated at 5-105°. In case of total quadriceps resection, knee extension reconstruction can be obtained with tendon transfers and reinnervated free muscular flaps. Combining these techniques could be a good strategy for rapid recovery, with optimal scarring and tissue coverage.

Keywords: Extension du genou; Free-flap; Grand dorsal; Knee extension; Lambeau libre; Latissimus dorsi; Reconstruction; Sarcome des tissus mous; Soft-tissue sarcoma; Tendon transfer; Transfert tendineux.