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An analysis of data of 348 patients with malignant tumors of soft tissues has shown that 128 of them had been subjected to the amputation of extremities at different levels. The use of microsurgical techniques favours the improvement of the method of amputation of lower extremities, in particular the transplantation of a calcaneoplantar flap onto the stump end. In order to make the treatment of phantom limb pains more effective acupuncture should be included into the complex of therapeutic measures in addition to traditional methods. Close contacts with prostheses-makers can facilitate earlier prosthesis which can give positive effects on the following rehabilitation of such patients.

There is no proven evidence that ablative surgery is superior to radical local surgery of bone tumors in the process of survival. When locally radical bone tumor resection is anatomically possible, such a procedure is advantageous. Skip lesions are extremely rare and can be detected at present by refined methods of diagnosis; thus, they do not interfere with the principle of local bone tumor surgery. Replacement of the skeletal defect obtained can be managed by specialized surgical methods. Massive autologous and/or homologous bone grafting is often a useful technique. For replacement of large defects, custom-made endoprostheses serve a useful purpose regarding limb function. Resection of the total shoulder girdle can be performed without sacrificing normal hand function. A corresponding resection of the hip area, including the acetabular ring, can save a lower extremity having a good or acceptable function. Differentiated bone tumor surgery also calls for differentiated rehabilitative measures.

The surgeon, by his manner and attitude, sets the tone for the rehabilitation program of the cancer patient who has undergone amputation. The initial encounter with the patient and his family tends to shape a relationship that persists throughout the treatment and rehabilitation program. In our practice, the surgeon remains the patient's physician before, during, and after the amputation. If the surgeon is also willing to direct the rehabilitation program, the continuity thus obtained is enormously helpful.

Functional outcome was evaluated in 40 patients with a diagnosis of soft tissue sarcoma (STS), who had received wide local surgical excision and postoperative radiation therapy. All patients were two or more years postsurgical excision, and 1.75 or more years postradiation. Patients were separated into three anatomic groups: head, neck, or trunk (HNT); lower extremity (LE); and upper extremity (UE). Each patient was assessed for range of motion, muscle strength, edema, pain, activities of daily living (ADL), and vocational changes. There was significantly more (p = 0.037) edema in patients with LE lesions than in patients in either of the other groups. Patients with LE lesions had greater difficulty with ADL and mobility than those with UE or HNT lesions (p = 0.019), and vocational changes were more frequent (p = 0.055). Patients with lower extremity STS are at higher risk for developing disability than patients with STS at other anatomic sites.

Forty-three patients with major three-dimensional orbitomaxillary defects underwent 48 free-tissue transfers for defects arising from resection of a neoplasm or trauma. Defects were complex, involving the malar skin, mandible, lateral nasal wall, orbit, palate, and brain. A three-dimensional approach attempting to recreate the midface by folding the flaps was the usual method, with subsequent revisions if necessary. Ten patients had simultaneous free bone grafts and 6 had vascularized bone grafts. There were three flap failures and four perioperative deaths. Excluding the 4 deaths, the results were assessed as excellent in 25 patients, good in 12, and poor in 2. Free-tissue transfer is a reliable method of providing enough tissue at one initial operation to satisfy complex three-dimensional defects of the orbitomaxillary region. Followed by minor revision, it provides a means of restoring function and appearance without multiple staged procedures with a high risk of failure.

On the basis of statistical data on neurosurgical therapy measures carried out in two five-year periods in adult patients with cerebral lesions, the need of rehabilitation, psychic peculiarities, and problems of social integration are discussed. The results of the neuropsychological examinations demonstrate the multifactorial dependence of inter-individual and environmental factors in postoperative problems. Aspects of psychological consultation, of special pedagogical therapy measures and of forms of communication are presented as promising possibilities of an optimisation of rehabilitation.