Radical Resection of Soft Tissue Sarcoma With Latissimus Dorsi Flap Reconstruction: Case Report

Introduction Soft tissue sarcomas (STS) are a group of rare tumours accounting for up to 1% of malignant tumor cases. Approximately 20% of STS cases are localised in the upper extremities, with the shoulder and upper arm region affected in half of these cases (1). The preferred surgical treatment for STS is limb-sparing surgery with wide local excision, which often requires reconstruction using flaps and augmented by radiation therapy or chemotherapy (2). Case Presentation An 85-year-old patient presented with a palpable mass in the right upper arm that was first noticed 3 months ago and has since grown in size. MRI revealed a heterogeneous tumor with the signs of necrosis measured 7 x 10.7 x 10.5 cm which has overgrown a part of deltoid and triceps muscles with no invasion to the humerus. A biopsy confirmed the diagnosis of undifferentiated pleomorphic sarcoma. CT scans of the chest, abdomen and pelvis showed no signs of distant metastasis. Incidentally, a low-frequency, possibly benign 3.5 x 1.8 x 8.5 cm sized mass was discovered in the lower right chest wall and the diagnosis of neurofibroma was confirmed with a biopsy. After multidisciplinary team discussion the treatment of choice was limb-sparing surgery with wide local excision of both tumors. The significant soft tissue defect after removal of the STS was reconstructed using pedicled latissimus dorsi flap. The patient had no post-operative complications and after wound healing, postoperative radiation therapy was administered. Further follow-up with MRI and CT scans of the chest, abdomen and pelvis after 6 months revealed local tumor recurrence with multiple subcutaneous nodes and metastasis to local lymph nodes and lung tissue. Discussion Oftentimes, rarely expected STS of the upper extremity cause no pain and grow slowly, complicating adequate early detection and treatment which becomes a major challenge for the multidisciplinary team (1). In the context of STS, the functional outcomes and possible complications of upper extremity soft tissue reconstruction with a latissimus dorsi flap have yet to be evaluated and analysed (3). Conclusions Although the surgery was performed radically, the waiting time for sufficient flap integration and proper function caused a long gap without radiation therapy, which led to disease recurrence.