Principles of Soft Tissue Coverage for Tumor Reconstruction (Hand)

Reconstruction of defects produced after tumor extrication differs significantly from that which is normally encountered in the treatment of traumatic defects. Immediate reconstruction should be anticipated and planned in most instances. The use of two surgical teams is advantageous. This avoids the tendency of the surgeon to compromise the resection or remove less tissue out of concern for maintaining reconstruction options.

Operating room personnel must adhere to strict precautions to prevent cross contamination of operative fields. This includes the use of separate draping, instruments, operative clothing, and personnel. The planning for reconstruction should include the possibility that the margins of resection might be positive.
If a local or rotation flap is to be performed, the potential for spread of the tumor to the donor site must be considered. Groin flaps should be avoided. The use of distant or free tissue transfer increases reconstruction complexity but reduces the risk of donor field contamination and is more frequently used after tumor reconstruction.

Vascularized bone transfer or soft tissue coverage may be particularly beneficial and may improve healing in those patients who need postoperative chemotherapy or radiation.

 Wide excision soft tissue sarcoma from the dorsum of the hand (A,B) with radial forearm flap for soft tissue coverage (C).