# Immediate Tendon Transfer for Functional Reconstruction in Upper Limb Sarcoma Surgery: An Observational Study

## TL;DR

This study shows that immediate tendon transfer can effectively restore function after nerve-sacrificing upper limb sarcoma surgery in low-resource settings.

## Contribution

The study provides evidence for the effectiveness of immediate tendon transfer in functional reconstruction following nerve sacrifice in upper limb sarcoma surgeries.

## Key findings

- The mean QuickDASH score significantly improved from 85.17 at 6 weeks to 11.95 at 12 months.
- The Musculoskeletal Tumor Society score increased from 8.57 to 25.71 after 12 months.
- All patients achieved Medical Research Council grading >4 at 12 months.

## Abstract

Upper limb sarcoma surgeries often require sacrificing major nerves to achieve oncologic control, leading to significant functional loss. In low-resource settings where microsurgical reconstruction is limited, immediate tendon transfer offers a practical solution for restoring function. This study evaluates functional outcomes following immediate tendon transfer in patients undergoing nerve-sacrificing sarcoma excision.

This multicentric observational study was conducted at four tertiary centers in Nepal: KIST Medical College and Teaching Hospital, National Trauma Centre, Bhaktapur Cancer Hospital and Nepal Cancer Hospital and Research Centre. The patients who underwent upper limb sarcoma surgery with immediate tendon transfer between January 2021 and May 2024 were included in the study. Data on demographics, tumor type, nerve involvement, surgical procedures, complications, and functional outcomes (Quick DASH, MSTS, and MRC grading) were collected and analysed using SPSS version 20.

This study included 14 patients, with a mean age of 34.07±17.05 years. There were 9 (64.28%) male, and dominant limb involvement was recorded in 10 (71.42%) patients. Bone sarcomas were present in 3 (21.42%) patients and soft tissue sarcomas in 11 (78.57%) patients. The radial nerve was sacrificed in 8 (57.14%) patients. The mean QuickDASH score decreased from 85.17 at 6 weeks to 11.95 at 12 months. The Musculoskeletal Tumor Society score increased from 8.57 to 25.71, and Medical Research Council grading was >4 in all patients at 12 months.

Immediate tendon transfer is an effective reconstructive strategy to restore function after nerve-sacrificing upper limb sarcoma surgery.