Reconstruction after unplanned excisions of soft tissue sarcomas using intraoperative extracorporeal autogenous irradiated bone and tendon grafts: a report of three cases

BACKGROUND: Wide resection of soft tissue sarcomas (STS) of the hand and foot is challenging due to limited soft tissue and complex anatomy. Reconstruction often requires tissue from healthy donor sites. To address this, we used intraoperative extracorporeal irradiation (ECI) of tumor-affected bones and tendons for reconstruction after wide resection. Herein, we report the oncological and functional outcomes using this technique. CASE PRESENTATION: Three patients who underwent unplanned excision of the hand or foot at another institution referred to our hospital for additional treatment. Case 1: A 46-year-old man with extraskeletal myxoid chondrosarcoma on the dorsal aspect of the left hand underwent wide resection followed by ECI bone and extensor tendon reconstruction with free flap coverage, and subsequently required tenolysis. At 5 years, he showed no recurrence and excellent function (Musculoskeletal tumor society (MSTS) score, 100%; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, 20.5). Case 2: A 27-year-old woman with synovial sarcoma of the dorsal right hand underwent wide resection and ECI bone and extensor tendon reconstruction. Delayed bone union required secondary bone grafting. She remained disease-free at 6 years with mild functional impairment (MSTS, 80%; QuickDASH, 29.5). Case 3: A 19-year-old woman with synovial sarcoma of the dorsal aspect of the right hallux underwent en bloc resection and ECI bone and extensor tendon reconstruction. At 4 years, she had no recurrence and excellent functional recovery (MSTS, 97%). CONCLUSION: Reconstruction using ECI-treated autogenous bone and tendon grafts allows effective oncological resection while preserving limb function and avoiding donor-site morbidity. Although mild degenerative changes were observed after osteoarticular reconstruction, all patients reported satisfactory outcomes and returned to their occupations. ECI is a valuable limb-salvage reconstruction option for STS of the hands and feet.