Resection of the Posterior Compartment of the Thigh

This chapter discusses the anatomic considerations, staging studies, techniques of biopsy and indications and contraindications to the treatment of posterior thigh sarcomas. In general, the posterior thigh (hamstring musculature) is the least common of the three compartments of the thigh for sarcomas to arise within. There is great variation in the size of tumors that occur in the posterior thigh, and variation in the location from a proximal location near the ischium to a distal location involving the popliteal space. The posterior thigh is a quiet surgical area with the most significant structure being the sciatic nerve. Almost all low-grade sarcomas can be resected safely. Most high-grade sarcomas can be resected by either a complete or partial muscle group resection. The sciatic nerve is rarely involved; even if resection is required, an amputation is not necessary. Preoperative examination must evaluate the ischium, ischiorectal space, the retrogluteal area, and the popliteal space for tumor extension. The most useful imaging studies are CAT and MRI scans. Angiography is required only if the tumor extends distally into the popliteal space. Function following posterior thigh resection is almost normal. Knee flexion is maintained by the remaining sartorius, gracilis, and gastrocnemius muscles.