Comparison of flap reconstruction for soft tissue sarcomas of the foot and ankle

Background: Foot and ankle soft tissue sarcomas (STS) are challenging for reconstruction due to limited surrounding soft tissue and weight-bearing requirements. Currently, there is a paucity of data examining the outcome of flap reconstruction following resection of a foot and ankle sarcoma. Methods: We reviewed 44 (31 female, 13 male) patients with STS arising from the ankle or foot which required coverage in the form of a free (n = 21), pedicled (n = 13), or rotational perforator flap (n = 10). The mean tumor size was 6 ± 5 cm, with 39 (89%) patients receiving radiotherapy. The mean follow-up was 10 ± 7 years. Results: There were no cases of amputation due to flap failure, with a 10-year limb salvage rate of 84%. Complications occurred in 19 (43%) patients, most commonly wound infections. There was no difference in the incidence of complications between patients undergoing a free flap and pedicled or perforator flap (odds ratio = 0.97, p = 1.0); with no difference in the mean Musculoskeletal Tumor Society (MSTS) score between patients with a free flap versus a pedicled/perforator flap (84% vs. 76%, p = 0.11). Conclusion: Flap reconstruction is an essential part of limb salvage for foot and ankle STS. At final follow-up nearly all the patients are ambulatory with an acceptable MSTS score.