Iatrogenic Metastasis of Soft-tissue Sarcoma at the Donor Flap Site: Case Report and Proposed Surgical Oncologic Techniques

An 81-year-old woman with multiply recurrent undifferentiated pleomorphic sarcoma of the foot underwent wide excision and reconstruction with an anterolateral thigh free flap. Six years postoperatively, she developed biopsy-proven recurrence within the harvest site. No other sites of disease were detected on staging workup. The flap site recurrence was attributed to iatrogenic implantation at the time of harvesting.Iatrogenic metastases are thought to be caused by tumor implantation, which may be attributable to cross-contamination from instrumentation and surgical techniques. In the present article, we highlight preventive techniques and oncologic surgical principles intended to reduce the likelihood of iatrogenic metastasis. Increased awareness by all members of the surgical team may prevent this unfortunate complication.