Complex Microsurgical Reconstruction After Tumor Resection in the Trunk and Extremities Omar N. Hussain, MD, M. Diya Sabbagh, MD, Brian T. Carlsen, MD* GENERAL CONSIDERATIONS IN ONCOLOGIC RECONSTRUCTION Thorough evaluation of the patients’ health sta- tus, functional demands, location, and extent of the tumor as well as the tissue loss expected with tumor ablation procedures must be done before attempting any course of treatment. A multidisciplinary team approach also helps the reconstructive surgeon in selecting the appro- priate flap for the defect and minimizing donor site defects, especially for trunk and lower ex- tremity reconstruction. 1 Accurate assessment of the defect, meticulous dissection of the recipient site, precise microvascular anastomoses, and proper flap insets are essential factors for an optimal outcome. The timing of the reconstruc- tion depends on the surgeon’s preference and the patients’ medical status, but it is preferable to do the reconstruction immediately after tumor resection. This approach decreases the number of operations and minimizes contamination of deep tissues and structures. 2–4 Reconstruction in patients with cancer is unique, as adjuvant chemotherapy and radiation therapy can affect wound healing and flap survival; neoadjuvant radiation therapy usually creates a zone of injury that extends beyond the margins of resection. Furthermore, patients with cancer are well known to be hypercoagulable and, there- fore, have a higher risk for venous thromboembo- lism. Chemotherapy, radiation, and immobilization further increase the risk of thromboembolic events in this special patient population. All of these fac- tors make oncologic reconstruction more chal- lenging and necessitates careful planning and individualization of treatment plans. 2,5–9 GOALS OF RECONSTRUCTION IN THE TRUNK The primary goals of chest wall reconstruction are stabilization of thoracic skeletal defects that may The authors have nothing to disclose. Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA * Corresponding author. E-mail address: Carlsen.Brian@mayo.edu KEYWORDS  Microsurgery  Extremities  Sarcoma  Flap  Limb salvage surgery  Trunk KEY POINTS  Soft tissue tumors of the trunk and extremities represent a challenge because of the paucity of soft tissue and the relative close proximity with critical structures.  A multidisciplinary team approach should be adopted, especially for the trunk and lower extremity.  Every attempt should be made to preserve a limb. When amputation is inevitable, the remaining limb must be optimized to maintain function or to improve prosthesis control.  Several flaps can be used to cover soft tissue defects in the trunk and extremity. Biological and syn- thetic materials can add to the wide variety of options in the armamentarium of the reconstructive surgeon. Clin Plastic Surg 44 (2017) 299–311 http://dx.doi.org/10.1016/j.cps.2016.11.008 0094-1298/17/Ó 2017 Elsevier Inc. All rights reserved. plasticsurgery.theclinics.com