Locally advanced soft-tissue sarcomas. An innovating triad to avoid amputation: isolated limb perfusion, tnf alpha, and free microsurgical flap

We retrospectively studied the benefits of isolated limb perfusion combined with TNF ALPHA administration and free flap reconstruction in locally advanced soft-tissue sarcomas of the limbs.
We treated 37 patients with locally advanced soft tissue sarcomas.
The sarcomas were located in lower and upper limbs and had a mean diameter of 15 cm and 12 cm.
They were multifocal in 8 cases and recurrent in 15 cases.
Seventeen patients received neoadjuvant chemotherapy: Adriamycin,
Sarcoma excision was combined with a complementary procedure in 10 patients: vascular graft or nerve anastomosis.
Reconstruction. was performed with free flaps of latissimus dorsi, n=31, transverse rectus abdominis flaps, n: 4 forearm flaps, N=2.
Early postoperative radiotherapy was administered in 25 cases.
The procedure lasted a mean of 6H 30.
The limb was preserved in 78% of cases
Thirteen patients developed pulmonary metastases and seven of them died.
With a median follow-up of 5 years, the overall survival rate was 65%.