# Total Quadriceps Resection in High-Grade Soft-Tissue Sarcomas of the Thigh: Surgical Technique and Long-Term Functional Outcomes in Surviving Patients

## TL;DR

This study examines the surgical outcomes of removing the entire quadriceps muscle in patients with thigh sarcomas, focusing on long-term function and recovery.

## Contribution

The paper introduces a surgical technique for total quadriceps resection and evaluates long-term functional outcomes in surviving patients.

## Key findings

- Total quadriceps resection ensures wide resection margins and local disease control in high-grade thigh sarcomas.
- Local muscle transfers are suitable for low-demand patients, while neurotized free flaps are better for young, motivated individuals.
- Wound complications are common, especially in older patients, though passive knee extension is achievable in all cases.

## Abstract

One challenge of compartmental resection of soft-tissue sarcomas of the anterior thigh is the disruption of the quadriceps extensor mechanism. The authors present their results in 10 patients followed postoperatively for a minimum of 4 years in the 5 surviving patients who underwent conservative surgical procedures and discuss their surgical technique to reestablish extensor function of the knee. Local muscle transfers are more suited for low-demand patients, while neurotized free muscle flaps are mainly an option for young, motivated patients. Resection appears to be technically easier if performed distally to proximally in the thigh.

Background: Reconstruction of the thigh extensor mechanism following wide excision of a soft-tissue sarcoma is difficult. The aim of this study was to describe the outcomes following complete quadriceps resection for large high-grade soft-tissue sarcomas. Methods: Ten patients with AJCC grade IIIB soft-tissue sarcomas of the anterior thigh were treated with total wide margin quadricectomy, with a mean follow-up of 4 years (range: 51–163 months) in the five surviving patients with conservative surgical procedures. The minimum follow-up period for four of these patients was 8 years. The extensor mechanism was reconstructed with local muscle transfers (eight cases) or a neurotized free flap of the contralateral vastus lateralis (two cases). Results: Four patients died, two due to non-tumor related causes and two due to metastatic disease at 50 months and 43 months. The remaining six were alive and disease-free at the final follow-up. All patients received surgical revision due to wound necrosis. Another patient required an external hemipelvectomy due to early local recurrence of the disease. Functional results of the five patients who remained alive and retained their limb were good or excellent in two cases, acceptable in one, and poor in two, according to their MSTS scores. Average knee flexion was 80° (range: 10–150°). Passive extension was complete in all cases, though no patients achieved it actively. Extensor strength was 2/5 in four patients and 4/5 in the other. Conclusion: Total quadricectomy for high-grade soft-tissue sarcomas of the anterior thigh compartment ensures wide resection margins and local disease control, although local wound complications are common, particularly in older patients. Resection appears to be technically easier if performed distally to proximally in the thigh. Local muscle transfers are more suited for low-demand patients, while neurotized free muscle flaps are mainly an option for young, motivated patients.