Latissimus dorsi muscle for functional reconstruction surgery of the triceps surae following soft tissue sarcoma resection

Reconstruction in the distal extremities is challenging due to paucity of local soft tissues and likelihood of impairment following sarcoma resection. Functional neurovascularized muscle transfer is a beneficial reconstructive option for restoring movement in an affected extremity in these cases. Functional reconstructions of the lower leg are rarely described, especially those involving the posterior compartment. We aim to report long-term outcomes of functional latissimus dorsi muscle transfer for triceps surae reconstruction following resection of sarcoma. A 59-year-old female reported enlarging masses on her right leg for which a biopsy revealed myxoid sarcoma. She underwent wide resection of the mass including the whole triceps surae muscles and Achilles tendon. Functional latissimus dorsi muscle transfer was performed to restore plantar flexion of the ankle joint. Neurovascular anastomoses of the subscapular artery with the posterior tibial artery, thoracodorsal vein with the comitant vein, and thoracodorsal nerve with the tibial motor nerve branch was completed using a microscope. Seven years post-surgery, there is no evidence of local recurrence of metastasis. Manual muscle testing of plantar flexion is 4 and musculoskeletal tumor society score is 90 %. Microvascular reconstructions are an essential part of modern sarcoma treatment. Functional muscle transfers have multiple benefits such as soft tissue coverage and restoration of joint movement, which were achieved in this case. Long term outcomes has shown that the functional latissimus dorsi muscle transfer flap is a viable option in the successful reconstruction of the triceps surae following sarcoma resection.