Radical resection for recurrent posterior thigh sarcomas often results in complete loss of knee flexor function with limited reconstructive options. We highlight the combined use of free functional latissimus dorsi (LD) transfer for knee flexion and sciatic nerve reconstruction for distal limb reinnervation after high grade sarcoma resection, a rarely reported approach to complex limb salvage.

A 65-year-old man with a painful posterior thigh mass with inability to flex the knee presented eight months after an unplanned excision (“Whoops” procedure) of a presumed benign tumour, later confirmed to be a sarcoma. Examination showed a posterior right thigh wound. Our work-up MRI revealed involvement of the hamstring muscles and sciatic nerve and histology confirmed pleomorphic sarcoma.

We offered neoadjuvant chemotherapy followed by posterior compartmentectomy with a 21 cm sciatic nerve resection and delayed soft tissue reconstruction using a functional LD innervated by posterior division of obturator nerve to restore knee flexion and nerve reconstruction using cabled sural nerve grafts for sciatic nerve reconstruction.