American Society for Peripheral Nerve

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A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: a need for general implementation.
Enrico Martin, MD1, Max J. Dullaart, BS1, Cornelis Verhoef, MD, PhD2 and J. Henk Coert, MD, PhD1, (1)University Medical Center Utrecht, Utrecht, Netherlands, (2)Erasmus Medical Center, Rotterdam, Netherlands

Background: Resection of nerves in extremity soft tissue sarcomas (STS) can lead to large functional deficits. Nerve reconstructions are rarely performed and little is known on their outcomes and indications for their use. The goal of this review is to summarize current knowledge on functional outcomes and considerations to be taken before performing such reconstructions after sarcoma resection.

Methods: A systematic search was performed in July 2018 in PubMed and Embase databases according to PRISMA guidelines. Search terms related to 'soft tissue sarcoma', 'nerve reconstruction', and 'functional reconstruction' were used. Studies evaluating functional outcomes after nerve grafting or nerve transfers in extremity soft tissue sarcomas were included. Qualitative synthesis was performed on all studies.

Results: Nineteen studies were included after full-text screening. A total of 26 patients were described, of which the majority had a nerve reconstruction in the upper extremity (65%). Perioperative radiotherapy was administered in 67% of aptients and perioperative chemotherapy in 29%. Nerve grafting was most commonly performed (n = 23) and nerve transfers were performed in six patients. A wide variety of outcome measures were used. Most patients recovered at least some motor function and sensation, but success rates were higher after upper than lower extremity defects. Multimodal treatment did not preclude successful reconstructions.

Conclusions: Nerve reconstructions in extremity STS allow the restoration of sensation in limb salvation. Reconstruction of motor nerve function can also restore satisfactory function. The use of multimodal therapy does not seem to preclude failure. Nerve reconstructions should be considered in STS patients.

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