Search

Purpose: This study aimed to investigate the relationship between various clinical factors and physical function in the early postoperative period in patients with soft tissue sarcomas (STSs) by subjective and objective evaluations., Materials and Methods: The 90 patients enrolled in this study were classified into five groups according to tumor location: retroperitoneal, gluteal, groin, thigh, and lower leg. The Musculoskeletal Tumor Society (MSTS) score was evaluated at discharge; the timed up-and-go test (TUGT) was performed preoperatively and at discharge. Group comparisons by tumor location were performed. To identify significant factors associated with physical dysfunction, multivariate analysis was performed using an MSTS score of <80% and a change in pre and postoperative TUGT score., Results: There were no significant differences between the tumor location and physical function. The change in pre- and postoperative TUGT scores was significantly associated with an MSTS score of <80%. Quadriceps and tibialis anterior muscle resections were significantly associated with the change in pre- and post-operative TUGT scores., Conclusions: The quadriceps and tibialis anterior muscles may affect physical dysfunction after surgery for STSs. Early postoperative rehabilitation should include the identification of resected muscles and functional improvement of residual muscles, possibly with orthotic support for knee extension and ankle dorsiflexion.

Introduction: The aim of this case series was to assess sports activity levels in long-term survivors of soft-tissue sarcomas after multimodal treatment including limb salvaging surgical resection and radio-chemotherapy. Methods: Thirty-two patients (17 f/15 m) with a mean age of 29 (range 10-44) years at the time of diagnosis and a mean follow-up time of 9 (range 3-21) years following sarcoma were included. Ten patients had been diagnosed with liposarcoma, seven with synovial sarcoma, four with fibrosarcoma, three with undifferentiated pleomorphic sarcomas and the remaining eight patients with different soft-tissue sarcoma entities. Sarcoma location of twenty-four (75%) patients was in the thigh, eight (25%) in the lower leg. Eleven (34%) tumors were located epifascial, 21 (66%) in deeper tissue layers. Sports activity was measured by the University of California, Los Angeles (UCLA) Activity Score. Results: One year before treatment 30 patients (94%) and >3 years post-treatment 29 patients (91%)had been pursuing athletic activity regularly. They were performing 5.5 h/week prior and 4.2 h/week >3 years post surgery. The mean UCLA score in case of subfascial sarcomas was 8.0 and thereby lower ( p  < 0.05) than those of epifascial sarcomas, which were 9.3. Furthermore, the mean UCLA score after subfascial sarcoma resection 3 years postoperative was still below preoperative UCLA levels ( p  < 0.05), whereas patients after epifascial tumor resection showed no loss of sports activity. No relation between complications and postoperative sports activity level was found. Conclusions: Healthy long-term survivors can achieve high levels of sports activity following limb salvage after soft-tissue sarcomas. The concerned muscle groups may influence the functional and sports outcome and draw attention to this topic in future rehabilitation. This knowledge may be of high value for patients counseling, physicians and orthopedists treating patients, as well as for patients inquiring information regarding post-treatment activity levels.Implication for rehabilitationSport is possible after soft tissue sarcoma treatment and longer-term rehabilitation which is usually three yearsRehabilitation is best undertaken in specialized centersIt is important to maintain contact with surgeons in order to optimize mobilizationHigh impact sports may be affected by deep muscle resections.

Objective: The aim of the study was to investigate the effects of a 4-wk inpatient rehabilitation program on postural control and gait in pediatric patients with cancer., Design: Eighty-eight patients with brain tumors (n = 59) and bone/soft tissue sarcomas (n = 29) were evaluated. Postural control was assessed examining the velocity of the center of pressure and single-leg stance time on a pressure distribution platform. Walk ratio, a measure of neuromotor control, was used to evaluate intervention effects on gait., Results: Repeated measures analysis of variance showed improvements in postural control measures, indicated by a decrease in velocity of center of pressure of -0.4 cm/sec (F1,80 = 7.175, P = 0.009, ηp = 0.082) and increase in single-leg stance time (mean [median] = 1.1 [2.6] sec, respectively; F1,80 = 12.617, P = 0.001, ηp = 0.136). Walk ratio increased by 0.2 mm/steps per min (F1,82 = 3.766, P = 0.056, ηp = 0.044). Mean changes in dependent variables did not differ between both patient groups (P > 0.05)., Conclusions: The results indicate benefits of an inpatient rehabilitation program comprising standard physical therapy as well as aquatic and hippo therapy on postural control and gait after treatment of pediatric patients with cancer.

Sarcomas are a relatively rare cancer that, depending on the location, can cause significant neuromusculoskeletal dysfunction and require rehabilitation interventions to reduce pain, restore function, and improve quality of life. This review focuses on sarcoma subtypes that frequently cause these complications: bony and soft tissue sarcomas leading to limb salvage or amputation, desmoid tumors, and malignant peripheral nerve sheath tumors. Rehabilitation approaches and outcomes are discussed, as well as considerations for childhood sarcoma survivors transitioning to adulthood., (Copyright © 2016 Elsevier Inc. All rights reserved.)

In this study, we present the feasibility of intercalary limb resection and massive reconstruction for malignant tumors of lower extremity. Ten cases of lower extremity malignancies that had undergone concomitant bone (and/or joint) and soft-tissue reconstruction after wide excision exceeding two-thirds of the cross-sectional area of the affected limb were reviewed. All cases were indicated for amputation because of an expansive tumor, hematoma from a pathologic fracture, or previous unplanned excision, with or without critical structure involvement. Bone was reconstructed with either an allograft or a tumor prosthesis. Soft-tissue reconstruction was performed to achieve critical structure and coverage, which was required in all cases. The resection margin was clear in all cases, and no soft-tissue graft failure was encountered. During a mean follow-up of 26 months (range, 9-42 months), no patient developed local recurrence in the resection-reconstruction site. Of the 10 patients, 8 patients were able to walk independently, and two were ambulatory but needed crutch support outdoors. Massive intercalary resection and reconstruction can be an effective treatment option for locally progressed or complicated lower extremity malignancies. Considering patient preference and the fair functional outcomes observed, it may be a useful alternative to amputation or rotationplasty., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: Limb salvage surgery comprises surgical techniques designed to resect musculoskeletal extremity tumors and subsequently reconstruct a limb with an acceptable oncologic, functional, and cosmetic result. Today, 70-90% of malignant extremity tumors are being treated with limb salvage surgery., Conclusion: The purpose of this article is to describe the operative techniques, review the imaging techniques, and to illustrate imaging findings related to the surgeries in complicated and uncomplicated cases.

We evaluated the oncological and functional outcome of 27 patients who had limb salvage for a soft-tissue sarcoma of the foot or ankle between 1992 and 2007, with a mean follow-up of 7.5 years (1.05 to 16.2). There were 12 men and 15 women, with a mean age at presentation of 47 years (12 to 84). Referrals came from other hospitals for 16 patients who had previous biopsy or unplanned excision, and 11 presented de novo. There were 18 tumours located in the foot and nine around the ankle. Synovial sarcoma was the most frequent histological diagnosis. Excision was performed in all cases, with 16 patients requiring plastic surgical reconstruction with 13 free and three local flaps. Adjuvant treatment was undertaken in 20 patients, 18 with radiotherapy and two by chemotherapy. Limb salvage was successful in 26 of the 27 patients. There have been two local recurrences and two mesenchymal metastases. Four patients have died of their sarcoma and two of other causes. Function was evaluated with the Toronto Extremity Salvage Score and a mean overall score of 89.40 (52.1 to 100) was obtained. A questionnaire revealed that all surviving patients are able to wear normal shoes and none require a walking aid. Limb salvage can achieve good oncological and functional results with additional treatment.

An 84-yr-old man presented with right posterior shoulder pain and growing mass. Shoulder range of motion was limited in forward elevation and abduction; result of the neurologic testing was normal. Radiologic workup showed an irregular mass resembling Paget's disease or sarcoma. On surgical inspection, a 16-cm hemorrhagic mass, occupying the entire scapula, was identified. Patient underwent tumor resection and scapulectomy. Postoperatively, he started a rehabilitation program. With attempted ambulation, patient exhibited strong tendencies to lean rightward, walked in circles, and risking fall. The gait abnormality could not be corrected and acute inpatient rehabilitation admission was recommended. A unique rehabilitation program was developed to correct gait deviation, improve balance, and compensate for deficits. After a comprehensive inpatient rehabilitation, the patient was successfully discharged home. We present a review of scapulectomy, postoperative care, and a recommended rehabilitation program.

The optimal management of adult soft-tissue sarcomas is not clearly established. To assess prognostic factors and survival, the experience of 45 recent successive cases was reviewed. Data were collected from a retrospective database (1993-2005) and statistically analyzed. Rhabdomyosarcomas were excluded. The mean age was 50.1 years; there were 24 men and 21 women. The main histological subtypes were undifferentiated sarcoma (14) and angiosarcoma (10); 21 tumours were grade 3 (46%). The most frequent primary sites were neck muscles (15, 33%) and scalp (11, 24%). At presentation, 5 (20%) cases with lymph-node involvement and another 11 cases (24%) with distant metastasis were observed. The treatment was with curative intent in 33 cases (73%). This entailed surgery, with adjuvant radiotherapy in 15 cases and adjuvant chemotherapy in 5 cases. The 5-year overall survival was 52% (+/-8%). In univariate analysis, the poor prognostic factors were high grade, initial metastasis or lymph nodes, absence of surgery, and number of surgical procedures. In multivariate analysis, two factors remained significant: grade (P=0.006) and absence of surgery (P=0.005). After taking into account grade and metastasis at presentation, quality of surgery has prognostic value. The primary aim of a multidisciplinary approach to these tumours must favour complete resection.

We evaluated the construct validity of the Musculoskeletal Tumour Society rating scale (Enneking score) as a functional measure for patients with sarcoma involving the upper limb. We compared the Enneking score by examining the correlation between two patient-derived outcome measures, the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Medical Outcomes Study Short Form-36 (SF-36) as indicators of functional status in 40 patients with malignant or aggressive benign bone and soft-tissue tumours of the upper limb who had undergone surgical treatment. The frequency distributions were similar among the three scoring systems. As for the validity, Spearman's rank correlation coefficient of the Enneking score to the DASH questionnaire was -0.79 and that of the Enneking to the SF-36 subscales ranged from 0.38 to 0.60. Despite being a measure from the surgeon's perspective, the Enneking score was shown to be a valid indicator of physical disability in patients with malignant or aggressive benign tumours of the upper limb and reflected their opinion.

Background: Nowadays, the results of the management of malignant bone and soft-tissue tumors have been dramatically improved because of the advance in imaging, chemotherapy, radiation therapy, and surgical techniques. Patients can have longer survival times with limb-salvage surgery. Several techniques of reconstruction have been advocated and gained more popularity following malignant tumor resection by using allograft, tumor prostheses, composite allograft prosthesis, or arthrodesis., Objective: To report the preliminary results of 32 endoprosthetic reconstructions following malignant bone and soft-tissue tumor resection. The oncologic results, functional outcomes, and complications from the surgery were assessed in the present study., Material and Method: Since September 1988, the authors have performed 188 limb-salvage surgical operations for the treatment of musculoskeletal tumors at Siriraj Hospital. From March 1994 to July 2006, 32 endoprosthetic reconstructions were performed on 30 patients following malignant bone or soft-tissue tumor removal. There were 16 males and 14 females with a mean age of 28 years (range 10-73). The diagnosis was conventional osteosarcoma in 16 patients, parosteal osteosarcoma in two patients, chondrosarcoma in two patients, leiomyosarcoma in two patients, failed allograft in two patients and one patient each of periosteal osteosarcoma, Ewing's sarcoma, Gorham's disease, synovial sarcoma, malignant fibrous histiocytoma, metastatic renal cell carcinoma, and prosthetic loosening. Wide excision was performed with a mean length of 18.5 cm (range 10-41). Five proximal femurs, 17 distal femurs, 1 total femur 3 proximal tibias, 1 intercalary tibia, 4 proximal humerus and 1 distal humerus were used for reconstruction. Modular replacement systems (MRS, Stryker/Howmedica/Osteonics) were the most common prostheses used in the present series., Results: The mean follow-up time was 26 months (range 6-128.7). Sixteen patients are continuously free of the disease, two are alive with the disease, two had no evidence of the disease, nine died of the disease, and one patient died from complication of hypertension. The mean Musculoskeletal Tumor Society functional analysis for upper extremity reconstruction was 93% (range 86.7-100) and for lower extremity was 89% (range 63.3-100). Two patients (6.7%) were determined to be a failure. Revision due to aseptic loosening was performed in one patient (3.3%) and one hip disarticulation was done related to local recurrence (3.3%). One patient with sciatic nerve palsy and two seromas was found and successfully treated in the present study., Conclusion: Endoprosthetic reconstruction could yield satisfactory results as a wide excision and limb-salvage for patients with malignant bone and soft-tissue tumors. Most patients in the present report had good to excellent functions following surgery and few complications occurred in the present report.

The treatment of most extremity bone or soft tissue sarcomas involves either limb salvage surgery with adjuvant chemoradiation therapy or amputation. The rehabilitation of patients with extremity sarcomas is challenging, and the approach differs depending on the choice of surgical procedure as well as potential-associated medical complications. Early, interdisciplinary rehabilitation involvement is helpful in lessening the impact of expected impairments and disability. There is a lack of evidence examining specific rehabilitation interventions in this patient population. Functional outcomes and quality of life studies suggest overall similar findings between limb salvage patients and amputees, but with differences in various subscales. Rehabilitation interventions are therefore individualized; based on the assessment of medical limitations, functional goals and expectations, and modification of environmental factors. Overcoming medical and oncologic barriers to rehabilitation; as well as psychological, structural, cultural, political, and economic barriers; can serve to lessen the degree of disability.

Background and Objectives: Unplanned excisions of soft-tissue sarcomas of the extremities occur commonly. Our goal was to evaluate the presence of residual disease, the treatment outcomes as they relate to local and distant recurrence and 5-year survival, and the limb functional outcomes in patients with unplanned sarcoma excision who were treated with re-excision and adjuvant therapy., Methods: Between 1993 and 1999, 42 patients presented to our institution after unplanned excision of soft-tissue sarcomas. Of those 42 patients, 38 without gross residual disease or metastatic lesions formed the basis of this review. All 38 patients underwent revision wide excision; most (31) also received adjuvant therapy (radiation and/or chemotherapy). Clinical data were obtained from analysis of patient records and radiographic studies. Univariate analysis was performed with logistical regression, and multivariate analysis was performed with Cox modeling., Results: The overall 5-year survival rate was 91.3% and the disease-free 5-year survival rate was 82.2%. Univariate analysis showed that stage-III disease (American Joint Committee on Cancer classification of soft-tissue sarcomas), lesions below the fascia, a histologic high-grade, and the development of organ metastasis were statistically significant factors for mortality. Stage-III disease also was significant for mortality on multivariate analysis. Only stage-III disease was significant for the development of local recurrence. Eighty-four percent of the patients had good to excellent functional outcomes., Conclusions: Re-excision with adjuvant therapy proved to be a safe and effective method for treating the disease and preserving limb function., (Copyright 2005 Wiley-Liss, Inc.)

The current standard of care for soft tissue sarcoma (STS) is limb salvage surgery and adjuvant radiotherapy, with long-term survival rates of approximately 70%. However, the extensive surgical resection and subsequent reconstruction result in 50% of survivors living with chronic disability. Rehabilitation aims to optimize functional independence and quality of life, and is routinely offered to patients undergoing surgical treatment for STS. Unfortunately, there is a dearth of research related to rehabilitation in this area. We propose a model for assessing disability, for designing treatment interventions and for evaluating rehabilitative outcomes in STS. The World Health Organization's (WHO) international classification of functioning, disability, and health (ICF) is divided into three domains: 1) impairments (related to body structure and function), 2) activity limitations (related to usual self-care activities/activities of daily living), and 3) participation restrictions (related to social roles). A literature review of STS rehabilitation reveals that most studies have focused on disability assessment, with few papers describing or evaluating rehabilitation interventions commonly employed in STS. Clinicians are forced to extrapolate findings from other patient populations in order to evaluate the effectiveness of specific rehabilitation strategies (ie, those used for particular sequelae of STS, such as lymphedema or impaired exercise tolerance). There is strongest support for complex decongestive physiotherapy (targeting lymphedema) and aerobic exercise interventions (aimed at alleviating cancer-related fatigue and psychosocial sequelae). The most poorly researched topic is rehabilitation for genitourinary disability (both incontinence and sexual dysfunction). Most studies related to oncologic rehabilitation are restricted to the impairment level (eg, affecting range of motion, muscle strength) of the ICF, with only a small minority addressing activity limitations (eg, affecting activities of daily living) experienced by patients. A consideration of participation restrictions (eg, fulfillment of vocational roles) is almost wholly absent from the literature. Yet social role reintegration is of fundamental importance to patients. Further research is required in these two domains. The ICF provides a comprehensive framework for future research into rehabilitation interventions for STS.

Objective: To determine outcomes of surviving patients who underwent transfemoral amputation as part of treatment for lower extremity malignancy at a mean 15 years postoperatively, with a minimum 2-year follow-up., Design: Retrospective, case control., Setting: Tertiary care university medical center., Patients: Thirty-five of 38 consecutively admitted patients free of metastatic disease managed with transfemoral amputation as part of treatment of a lower extremity bone and/or soft tissue malignancy between 1966 and 1997 at 1 institution. The control group included 35 age- and gender-matched subjects recruited from the local driver's license office., Interventions: Not applicable., Main Outcome Measures: Musculoskeletal Function Assessment (MFA), Short Form-12 General Health Status Survey (SF-12), physical performance battery, cost, and demographic data., Results: Controls showed superior scores as measured by the MFA (P < .0001), the physical component summary of the SF-12 (P = .0002), and the physical performance battery (P < .0001), but had inferior scores on the mental component summary of the SF-12 (P < .0001). With the numbers available, no differences were found between study and control subjects in terms of employment rate (P = .51), education level (P = .66), income level (P =.44), marital status (P = .79), incidence of self-reported health problems (P = .14), and alcohol (P =.42) and tobacco (P = .82) use. Ten patients were included in the cost analysis; the mean cost to obtain and maintain a lower extremity prosthesis was $4225 per year (range, 623 dollars-8517 dollars)., Conclusions: Although the decrease in physical performance was anticipated in the study group, the group differed very little from the control population in terms of employment, education level, income, marital and home status, incidence of self-reported health problems, incidence of self-reported depression, and alcohol and tobacco use. Also, the long-term cost of maintaining a lower extremity prosthesis is noted., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

We evaluated the number of steps, activities of daily life (ADL) score, Enneking score, active range of motion and muscle strength by muscle manual testing for function in lower limbs after reconstructive procedures in surgical treatment of tumors. The 56 patients with 20 malignant bone tumors and 36 malignant soft-tissue tumors averaged 7119 +/- 3563 steps per day, or 69.8% of the control group. The average ADL score of patients was 14.0 +/- 4.1 points (70.0%), and the average Enneking score 20.4 +/- 6.0 points (68.0%). The scores of the bone tumor group were lower than those of the soft-tissue tumor group. These scores were not correlated with the range of motion. The number of steps and ADL score were correlated with Enneking score (coefficient 0.52 and 0.84, respectively). The number of steps and the ADL score appear to be useful, as is Enneking score.

The studies reporting functional outcome for patients undergoing limb preservation surgery for extremity soft tissue sarcoma (STS) have evaluated mainly impairments, that is, deficits at an anatomic structure level, such as joint range of motion and strength. Disability, activities of daily living, self-care, and mobility have been less frequently evaluated. Review of the literature suggests that approximately 50% of patients treated for STS have significant impairments, whereas the frequency of disability is less. Synthesis of the results is difficult because of the heterogeneity of patient samples, treatment, and the outcomes used to evaluate function. Future studies require the use of standardized definitions and reliable and valid functional outcome measures. Improved patient outcomes can be achieved only by understanding the determinants of these outcomes and by introducing interventions to improve patient functional outcome.

Objective: To quantify the differences in physical disability and handicap experienced by patients with lower extremity sarcoma who required amputation for their primary tumor as compared with those treated by limb-sparing surgery., Design: Matched case-control study. Twelve patients with amputation were matched with 24 patients treated by limb-sparing surgery on the following variables: age, gender, length of follow-up, bone versus soft-tissue tumor, anatomic site, and treatment with adjuvant chemotherapy., Patients: Patients who underwent above-knee amputation (AKA) or below-knee amputation (BKA) for primary soft-tissue or bone sarcoma, who had not developed local or systemic recurrence, and who had been followed up for at least 1 year since surgery., Main Outcome Measures: The Toronto Extremity Salvage Score (TESS), a measure of physical disability; the Shortform-36 (SF-36), a generic health status measure; and the Reintegration to Normal Living (RNL), a measure of handicap., Results: Mean TESS score for the patients with amputations was 74.5 versus 85.1 for the limb-sparing patients. (p = .15). Only the physical function subscale of the SF-36 showed statistically significant differences, with means of 45 and 71.1 for the amputation versus limb-sparing groups, respectively (p = .03). The RNL for the amputation group was 84.4 versus 97 for the limb-sparing group (p = .05). Seven of the 12 patients with amputations experienced ongoing difficulty with the soft tissues overlying their stumps., Conclusions: There was a trend toward increased disability for those in the amputation group versus those in the limb-sparing group, with the amputation group showing significantly higher levels of handicap. These data suggest that the differences in disability between amputation and limb-sparing patients are smaller than anticipated. The differences may be more notable in measuring handicap.

1. Adequate complete surgical resection with a oncologic radical or wide margin of normal tissue represents the most important measure to prevent a local recurrence. Limited excision with "shelling-out" of the tumor, through its "pseudocapsule" almost invariably means positive microscopic margins. The pathohistologically or macroscopically marginal or intralesional positive resection margins make a salvage surgery necessary. 2. A close safety margin of < 1 cm due to neighboured anatomic structures indicates a high risk of local recurrence and makes an adjuvant radiotherapy mandatory. Plastic-reconstructive surgery should prepare the radiotherapy fields, to avoid cavities or ulcerations. 3. Facts should be stated in the clinical record and the operation report, e.g. the safety margin should be defined by the surgeon and the pathologist; the histopathologic stage and grade are absolutely basic requirements. If necessary, a second histopathologic review should be asked for. 4. Tumor resection and reconstructive oncoplastic measures should correspond individually to the oncologic parameters, to the functional demands and to the age of the patient. 5. Multidisciplinary cooperation in a tumorboard is a precondition for an adequate treatment.

Many of the current and future directions in cancer rehabilitation have been briefly discussed; and some of the important areas for development are outlined in Table 1. Implementation of rehabilitation measures may be facilitated by organized and creative multidisciplinary rehabilitation programs. Advances are also dependent on health care policy, particularly in reimbursement for rehabilitation services and in the funding of rehabilitation research. Much progress can be expected in the years ahead.

Data of 13 patients with tumors of the locomotor system subjected to +interscapular-thoracic resection (ITR) are presented. Main technical aspects of ITR are described. Complications took place in 6 patients, including marginal necrosis of the skin in 4 patients. As a whole the 5-year survival made up 49.9% +/- 13.8%. Data are presented on rehabilitation measures which allow to widen the functional possibilities of the extremity.

Amputation is still necessary to achieve disease-free margins in some patients with osteogenic sarcoma. Improving the quality of life for this largely young patient population has become increasingly important considering the dramatic increase in their survival rate. A multidisciplinary approach should include prosthetic devices that are comfortable and lightweight, and produce an energy-efficient gait, an aggressive postoperative rehabilitation, and an objective evaluation of progress. This approach will help improve the high net energy expenditure of ambulation and the asymmetrical stance time experienced by this group of individuals and allow them to gain equal status in society.

The physiatrist's chief concern for the child with an amputation secondary to tumor is that of comprehensive prosthetic rehabilitation. Problems unique to these children, factors which affect restoration favorably or unfavorably, principles of management, and measures of outcome are described and also illustrated by a case history. A multidisciplinary pediatric amputee clinic is recommended as the optimal setting for a prosthetic rehabilitation program.

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.

Forty-six patients who had undergone excision of one or more well defined hip and/or thigh muscles because of a soft-tissue tumor or a tumoriform lesion were investigated with respect to the function of the operated limb and the isometric and isokinetic strength of the affected motion or motions, relative to the non-operated side (percentage). Hip flexion: Loss of the iliopsoas caused slight impairment of function. The flexion strength decreased with increasing flexion of the hip joint. Loss of the rectus femoris reduced the isometric strength by 37 and the isokinetic strength by 17 per cent. Hip abduction: The strength reduction was only about 50 per cent and the impairment of function only slight or moderate even in patients with extensive loss of abductor muscles. Hip adduction: Removal of all three prime adductors (longus, brevis, magnus) caused a strength reduction of about 70 per cent but the impairment of function was only slight or moderate. Hip extension: Loss of the gluteus maximus caused only a small strength reduction and no impairment or only slight impairment of function. Significant strength reduction was only seen when all hamstrings had been removed. Knee extension: Loss of one, two, and three of the quadriceps muscles reduced the isometric strength by 22, 33, and 55 per cent, respectively. The isokinetic strength was reduced somewhat more. The strength reduction usually had to exceed 50 per cent to cause more than slight impairment of function. Knee flexion: Loss of the semitendinosus, the biceps femoris, and all the hamstrings reduced the isometric strength by 24, 28, and 67 per cent, respectively. The isokinetic strength was reduced somewhat less. Loss of one of the hamstrings usually caused no impairment of function whereas loss of all three resulted in moderate impairment of function.

Two cases of Tikhor-Linberg resection for rhabdomyosarcoma and malignant chondromyxoid fibroma and two cases of scapulectomy for metastatic disease of the shoulder girdle are reviewed. After resection of the scapula, active motion of the shoulder will be severely restricted, but normal function of elbow, wrist, and hand permit use of the extremity in many activities of daily living. Surgical treatment for metastatic bone disease in the upper extremity and the role of radiation therapy for metastatic bone disease are discussed.

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.