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Objective: To evaluate the long-term results of 20 years of experience with isolated limb perfusion (ILP) with tumour necrosis factor α (TNF-α) and melphalan, followed by surgical resection and adjuvant radiotherapy, for the treatment of advanced soft tissue sarcomas of the extremities., Design: Retrospective cohort study., Method: From 1991 to 2011, 113 patients with primary irresectable soft tissue sarcomas underwent 117 ILPs at the University Medical Centre Groningen. 96 ILPs (82%) were performed in the lower limb, and 21 (18%) in the upper limb. The dosages used were 1-4 mg TNF-α and 10-13 mg/l melphalan., Results: After a median follow up of 8 (range 2-15) weeks after ILP, 107 tumours were resected: 81 (76%) of the resection margins were tumor-free. After the resection, 69 patients (61%) received adjuvant radiotherapy. In total, 85 ILPs resulted in a tumoural response; 16 patients (14%) developed a local recurrence and after 46 treatments (39%), distant metastases had developed. After a median follow-up of 51 months, the limb had been spared in 88 patients (78%). The 10- year disease-specific survival was 53.8%. There was a median follow-up period of 76 months (range: 7-234); still alive at the end of this period were 56 patients (50%). A total of 83 perfusion- or resection-related complications occurred from 58 ILPs (50%): 55 (66%) early and 28 (34%) late treatment-related complications. None of the patients died as a result of the treatment., Conclusion: ILP is a safe and effective procedure in the treatment of advanced primary irresectable soft tissue sarcoma that can prevent amputation in many cases. It is however associated with significant morbidity and is burdensome for the patient.

Four patients presented with tissue damage after having surgery and radiotherapy for a malignancy. Two patients presented with ischaemic tissue damage many years after treatment--a woman aged 71 presented 40 years after and a man aged 56 presented 12 years after treatment. A 44-year-old-woman presented with chronic seroma after surgical resection, which had been aggravated by radiotherapy. In a man aged 48, a chronic infection in irradiated tissue did not respond to antibiotics. These complications proved to be resistant to conservative treatment and surgery was indicated. All patients underwent resection of the damaged irradiated tissues and transposition of the greater omentum, which proved to be effective. The pedicled omentoplasty is able to transpose well-vascularized tissue with angiogenetic and immunological properties to tissues with no spontaneous healing capacity.