Effects of a tailored rehabilitation treatment in lower limb Soft Tissue Sarcomas reconstruction: a case series

The primary treatment for lower limb Soft Tissue Sarcoma (LL-STS) consists of wide surgical resection followed by the Free Functional Muscle Transfer (FFMT) when restoration of muscular continuity and contractile function is needed. Despite the promising results, this approach led to the onset of neuromotor disabilities, reducing the patients’ sensorimotor capabilities during walking. Nowadays, the role of rehabilitation in neuromuscular recovery after FFMT has not been deeply analyzed. The aim of the study was to evaluate the effect of a customized rehabilitation protocol on walking capabilities of patients with LL-STS who underwent radical resection followed by microsurgery reconstruction using FFMT. Three patients after wide surgical resection and microsurgical reconstruction followed a personalized rehabilitation protocol according to the site of the lesion (hamstrings or quadriceps). Their ambulation performance was evaluated at the beginning, at the end of rehabilitation, and at long-term follow-up using an optoelectronic system, surface and invasive electromyography. Simultaneously, a clinical survey on physical limitations, post-operative neuropathic pain, and perceived quality of life was submitted to the patients. The patients showed progressive improvements in lower limb joint kinematics and spatio-temporal parameters for both limbs. These results were confirmed by the electromyography analysis demonstrating a complete reinnervation of the flap in all cases, with muscle activation patterns close to physiological one. Indeed, the patients developed coordinated activation patterns and compensatory strategies in the hamstrings and quadriceps femoris that supported limb stability and joint control during movement. The clinical scales demonstrated both a reduction in neuropathic pain and an improvement in physical functionalities and perceived quality of life. The proposed rehabilitation approach was effective in enhancing ambulation performance of patients following FFMT. These results highlight the critical role of rehabilitation in maximizing functional outcomes after complex oncologic-musculoskeletal surgeries. Trial registration ClinicalTrials.gov (ID NCT06282237, Registration date: 2024-02-28)