Publication: Immediate Tendon Transfer for Functional Reconstruction in Upper Limb Sarcoma Surgery: An Observational Study
Date
2025
Journal Title
Journal ISSN
Volume Title
Publisher
Nepal Medical Association
Abstract
Abstract
Introduction: 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.
Methods: 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.
Results: 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.
Conclusions: Immediate tendon transfer is an effective reconstructive strategy to restore function after nerve-sacrificing upper limb sarcoma surgery.
Description
Basanta Maharjan
Department of Orthopedics, KIST Medical College and Teaching Hospital & Nepal Cancer Hospital and Research Centre, Imadol, Lalitpur, Nepal
Janith Singh
Department of Orthopedics, National Trauma Center, Mahaboudha, Kathmandu Nepal
Dipendra Maharjan
Department of Orthopedics, Nepal Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
Binayak Dhungel
Ortho-Onco Unit, Bhaktapur Cancer Hospital, Dudhpati, Bhaktapur, Nepal
Rishi Ram Poudel
Department of Orthopedics, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
Krishna Jung Sah
Department of Orthopedics, Provincial Hospital Malangawa, Malangawa, Sarlahi, Nepal
Prashanna Dip Karki
Department of Orthopedics, B&B Hospital, Gwarko, Lalitpur, Nepal