Lymphatic Complications Prevention and Soft Tissue Reconstruction after Soft Tissue Sarcoma Resection in the Limbs

Background and Objectives: The definitive treatment of soft tissue sarcomas (STS) requires a radical surgical removal of the tumor, which often leads to large soft tissue defects. When they are located in the limbs, significant damage to the lymphatic pathways is not uncommon. In the present article, we present different techniques aimed at both reconstructing the defect and restoring sufficient lymph drainage, thus preventing short- and long-term lymphatic complications. Materials and Methods: Between 2018 and 2020, 10 patients presenting a soft tissue defect with lymphatic impairment received a locoregional reconstruction by means of either pedicled or free SCIP flap. Seven patients required a second flap to reach a good dead space obliteration. In six cases, we performed an interpositional flap, namely a soft tissue transfer with lymphatic tissue preservation, and in four cases a lymphatic flow-through flap. In all cases, the cause of the defect was STS surgical excision. The average age was 60.5 years old (ranging 39–84), seven patients were females and six were males. Results: All the patients were successfully treated. In two cases, minor post-operative complications were encountered (infected seroma), which were conservatively managed. No secondary procedures were required. The average follow-up was 8.9 months (ranging 7–12 months). No signs of lymphedema were reported during this time. In all cases, complete range of motion (ROM) and a good cosmetic result were achieved. Conclusions: A reconstructive procedure that aims not only to restore the missing volume, but also the lymphatic drainage might successfully reduce the rate of postoperative complications. Both lymphatic interpositional flaps and lymphatic flow-through flaps could be effective, and the right choice must be done according to each patient’s needs.

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Nanofiber-hydrogel composite–mediated angiogenesis for soft tissue reconstruction

Science Translational Medicine ◽

10.1126/scitranslmed.aau6210 ◽

2019 ◽

Vol 11 (490) ◽

pp. eaau6210 ◽

Cited By ~ 30

Author(s):

Xiaowei Li ◽

Brian Cho ◽

Russell Martin ◽

Michelle Seu ◽

Chi Zhang ◽

...

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Rabbit Model ◽

Soft Tissue Defect ◽

Fat Grafting ◽

Foreign Body Response ◽

Soft Tissue Reconstruction ◽

Hydrogel Composite ◽

Tissue Flaps ◽

Tissue Restoration

Soft tissue losses from tumor removal, trauma, aging, and congenital malformation affect millions of people each year. Existing options for soft tissue restoration have several drawbacks: Surgical options such as the use of autologous tissue flaps lead to donor site defects, prosthetic implants are prone to foreign body response leading to fibrosis, and fat grafting and dermal fillers are limited to small-volume defects and only provide transient volume restoration. In addition, large-volume fat grafting and other tissue-engineering attempts are hampered by poor vascular ingrowth. Currently, there are no off-the-shelf materials that can fill the volume lost in soft tissue defects while promoting early angiogenesis. Here, we report a nanofiber-hydrogel composite that addresses these issues. By incorporating interfacial bonding between electrospun poly(ε-caprolactone) fibers and a hyaluronic acid hydrogel network, we generated a composite that mimics the microarchitecture and mechanical properties of soft tissue extracellular matrix. Upon subcutaneous injection in a rat model, this composite permitted infiltration of host macrophages and conditioned them into the pro-regenerative phenotype. By secreting pro-angiogenic cytokines and growth factors, these polarized macrophages enabled gradual remodeling and replacement of the composite with vascularized soft tissue. Such host cell infiltration and angiogenesis were also observed in a rabbit model for repairing a soft tissue defect filled with the composite. This injectable nanofiber-hydrogel composite augments native tissue regenerative responses, thus enabling durable soft tissue restoration outcomes.

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COVERAGE CONSIDERATIONS AND OUTCOME ANALYSIS OF RECONSTRUCTION OF POST TRAUMATIC SOFT TISSUE DEFECTS AROUND THE ELBOW

10.36106/ijsr/8502139 ◽

2020 ◽

pp. 70-72

Author(s):

Vishwamitra B Dayal ◽

M. Senthil Kumaran ◽

S Raja Sabapathy

Keyword(s):

Soft Tissue ◽

Soft Tissue Defect ◽

Defect Size ◽

Outcome Analysis ◽

Soft Tissue Reconstruction ◽

Soft Tissue Defects ◽

Comparison Results ◽

Average Defect ◽

A Prospective Study ◽

Tissue Defects

Introduction: Major crush injury of elbow joint following trauma with extensive injury to skin & soft tissue, bone, tendon, nerves and vessels remains a challenge to the reconstructive surgeon. Purpose of this study is to nd out whether the size of the defect, type of ap used and the location of the soft tissue defect inuence the outcome of soft tissue reconstruction. Material and methods: A prospective study was performed in all patients with soft tissue defects around the elbow in need of ap cover at Ganga Medical Centre Coimbatore, Tamilnadu India from April 2014 to December 2015.Patients demographics, defect size, location, type of ap used, complications and long – term outcomes analysed. Patients Mayo elbow performance score and Likert scale score were recorded for analysis of functional and aesthetic outcome respectively. The Kruskal wallis test was used for statistical comparison. Results: Forty three aps were performed primarily for coverage in forty patients. Three patients required two primary aps for reconstruction. The aps used in our study included 14 local fasciocutaneous aps (32.5%); 20 pedicled aps both locoregional and distant (46.5%) and 9 2 2 Anterolateral thigh free aps (20.9%) The average defect size was 151 cm . For local fasciocutaneous ap the average defect size was 44.7cm , 2 2 2 2 2 (range, 4-120 cm ), distant pedicled ap was181 cm (range 24- 600 cm ) and for the ALT free ap was 252.2 cm (range 80-450 cm ). Conclusion: The defect size is the main determinant of the type of ap used and their outcomes.

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An Extraordinary Reconstruction of a Postoperative Defect after Metatarsophalangeal Joint Arthrodesis of the Big Toe Using the “Chinese Forearm Flap”

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1373-6466 ◽

2021 ◽

Author(s):

Andrej Ring

Keyword(s):

Soft Tissue ◽

Metatarsophalangeal Joint ◽

Posterior Tibial Artery ◽

Hallux Rigidus ◽

Soft Tissue Defect ◽

Medial Malleolus ◽

Soft Tissue Reconstruction ◽

Tissue Defect ◽

Posterior Tibial ◽

Tibial Artery

Abstract Background We present an unusual technique for reconstruction of a postoperative tissue defect following hallux rigidus surgery. Methods A complicated course after left big toe arthrodesis resulted in a soft tissue defect with bone exposure of the first ray. Amputation of the big toe was categorically rejected by the patient. There was advanced arteriosclerosis with single-vessel supply to the foot via the posterior tibial artery. Outcome To preserve the big toe, the defect was covered by a fasciocutaneous radial free flap with a 15 cm long vascular pedicle which was microanastomosed to the posterior tibial artery and its accompanying vein at the level of the medial malleolus. Conclusion In certain extreme situations, the free “Chinese” radial flap can be quite effective in covering forefoot defects and allowing satisfactory and aesthetically pleasing soft tissue reconstruction.

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Unresected pediatric myoepithelial carcinomas treated with alternating chemotherapy cycles with adjuvant radiotherapy

Asian Journal of Oncology ◽

10.4103/2454-6798.173406 ◽

2015 ◽

Vol 01 (02) ◽

pp. 109-111

Author(s):

Michael Dorbad ◽

Peter Lim ◽

Jeffrey Taylor

Keyword(s):

Soft Tissue ◽

Adjuvant Radiotherapy ◽

Pediatric Population ◽

Surgical Excision ◽

Surgical Removal ◽

Myoepithelial Carcinoma ◽

Primary Tumors ◽

Vertebral Involvement ◽

Alternating Chemotherapy ◽

Tissue Origin

ABSTRACTMyoepithelial carcinomas of soft tissue origin are rare tumors in the pediatric population. Due to the rarity of this malignancy, very few cases have been reported in the literature, and a consensus on treatment has not been established. Most myoepithelial carcinomas of soft tissue present in the extremities and are treated with surgical excision followed by adjuvant radiotherapy. We report 2 cases of pediatric myoepithelial carcinoma presenting with vertebral involvement making complete surgical removal impossible. These patients underwent chemotherapy and adjuvant radiotherapy as the main treatment for their primary tumors.

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A case series of flow-through free anterolateral thigh flap to augment the vascularity of ischaemic limbs with soft tissue defect

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.182229 ◽

2016 ◽

Vol 49 (01) ◽

pp. 35-41 ◽

Cited By ~ 1

Author(s):

Aditya Aggarwal ◽

Hardeep Singh ◽

Sanjay Mahendru ◽

Vimalendu Brajesh ◽

Sukhdeep Singh ◽

...

Keyword(s):

Soft Tissue ◽

Limb Salvage ◽

Soft Tissue Defect ◽

Single Step ◽

Anterolateral Thigh Flap ◽

Vascular Repair ◽

Tissue Defect ◽

Soft Tissue Cover ◽

Anterolateral Thigh ◽

Flow Through

ABSTRACT Introduction: In a world of fast moving vehicles, heavy machinery and industries crush injury to limbs with vascular compromise and soft tissue defect is common. The traditional treatment is a 2 step one dealing with vascular repair and soft tissue cover separately, in the same operation. We report a series of single step vascular repair and soft tissue cover with flow through anterolateral thigh flap (ALT) flap for limb salvage. Materials and Methods: Ten patients with soft tissue defect and vascular injury were included in this study. A two team approach was used to minimise operative time, team one prepared the vessels and team 2 harvested the flap. Observations and Results: Of the ten patients operated (8 males), eight flaps were done for upper limb and two for lower limb salvage. Six anastomosis were done with ulnar vessels, two with radial and two with posterior tibial vessels. Nine extremities could be salvaged while one patient developed progressive thrombosis leading to amputation. Conclusion: The ALT flow-through flap is a versatile single step procedure that can be used to salvage an ischemic limb with soft tissue loss avoiding the need for interpositional vein graft.

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A Case of “en bloc” Excision of a Chest Wall Leiomyosarcoma and Closure of the Defect with Non-Cross-Linked Collagen Matrix (Egis®)

Case Reports in Oncology ◽

10.1159/000452147 ◽

2016 ◽

Vol 9 (3) ◽

pp. 655-660 ◽

Cited By ~ 1

Author(s):

Marco Rastrelli ◽

Saveria Tropea ◽

Romina Spina ◽

Alessandra Costa ◽

Roberto Stramare ◽

...

Keyword(s):

Soft Tissue ◽

Chest Wall ◽

Tissue Regeneration ◽

Soft Tissue Sarcomas ◽

Surgical Excision ◽

Smooth Muscle Tumor ◽

Chest Wall Resection ◽

En Bloc ◽

Dermal Matrix ◽

Treatment Protocols

Sarcomas arising from the chest wall account for less than 20% of all soft tissue sarcomas, and at this site, primitive tumors are the most frequent to occur. Leiomyosarcoma is a malignant smooth muscle tumor and the best outcomes are achieved with wide surgical excision. Although advancements have been made in treatment protocols, leiomyosarcoma remains one of the more difficult soft tissue sarcoma to treat. Currently, general local control is obtained with surgical treatment with wide negative margins. We describe the case of a 50-year-old man who underwent a chest wall resection involving a wide portion of the pectoralis major and minor muscle, the serratus and part of the second, third and fourth ribs of the left side. The full-thickness chest wall defect of 10 × 8 cm was closed using a non-cross-linked acellular dermal matrix (Egis®) placed in two layers, beneath the rib plane and over it. A successful repair was achieved with no incisional herniation and with complete tissue regeneration, allowing natural respiratory movements. No complications were observed in the postoperative course. Biological non-cross-linked matrix, derived from porcine dermis, behaves like a scaffold supporting tissue regeneration; it can be successfully used as an alternative to synthetic mesh for chest wall reconstruction.

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A maxillary ameloblastic fibrosarcoma tumor: a rare case report from Syria

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa255 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Amjad Soltany ◽

Ghazal Asaad ◽

Rami Daher ◽

Mouhannad Dayoub ◽

Ali Khalil ◽

...

Keyword(s):

Case Report ◽

Soft Tissue ◽

Rare Case ◽

Soft Tissue Sarcomas ◽

Surgical Excision ◽

Low Grade ◽

Rare Case Report ◽

Ameloblastic Fibrosarcoma ◽

The Right

Abstract Ameloblastic fibrosarcoma (AFS) is a rare, aggressive malignant odontogenic tumor. AFS is seen most frequently in second and third decades of life. We are reporting a case of a low grade AFS in a 21-year-old male complaining of a painless swelling in the right side of the maxilla. The patient was treated with surgical excision followed by radiotherapy, which is considered the most effective approach for most of soft tissue sarcomas. AFS has a high-reported recurrence rate (up to 37%); therefore, long-term surveillance for recurrence is crucial.

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Reverse sural artery fasciocutaneous flap in soft tissue reconstruction in lower extremity

Journal of Chitwan Medical College ◽

10.3126/jcmc.v10i3.32055 ◽

2020 ◽

Vol 10 (3) ◽

pp. 84-87

Author(s):

Suresh Pandey ◽

Suraj Bidary

Keyword(s):

Soft Tissue ◽

Demographic Data ◽

Soft Tissue Defect ◽

Soft Tissue Reconstruction ◽

Superficial Infection ◽

Pedicle Flap ◽

Satisfactory Outcome ◽

Flap Procedure ◽

Tissue Reconstruction ◽

Sural Artery

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue reconstruction around the ankle and distal leg. Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0. Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics. Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.

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Cost-utility analysis of surveillance strategies for soft tissue sarcoma recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.11565 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 11565-11565

Author(s):

Bonny Chau ◽

Marita Zimmermann ◽

Michael Wagner ◽

Lee D. Cranmer

Keyword(s):

Cost Effectiveness ◽

Soft Tissue ◽

Imaging Modality ◽

Soft Tissue Sarcomas ◽

Definitive Treatment ◽

Published Data ◽

X Rays ◽

Life Years ◽

Screening Intervals

11565 Background: Soft tissue sarcomas (STS) are uncommon malignancies with significant biological and clinical variation. After primary curative therapy, patients enter a program of surveillance for recurrence with periodic chest x-rays (CXR) or computed tomography (CT). We compared costs and health outcomes of CXR and CT at a range of frequencies and durations of follow-up. Methods: We used a Markov model to simulate a cohort of 10,000 STS patients through their surveillance experience for lung metastasis after completion of definitive treatment for stage II or III primary disease. Health states in the model were no evidence of disease, recurrence, and death. We assessed the method of chest imaging, duration of follow-up, and interval (every 3 months or 6 months) of surveillance in the first 3 years. Cost effectiveness was assessed for each screening modality and screening frequency. Recurrence probabilities, utilities, treatment costs, and other parameters were from previously published data. Outcomes were costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER). Results: The initial evaluation comparing screening every 3 months for 3 years, every 6 months for years 4 and 5, and annually from years 6 to 10 resulted in 632,264 QALYs and $1,038,351,481 costs for CT, compared to 631,834 QALYs and $746,019,937 for CXR, resulting in an ICER of $679,322/QALY. In comparing screening intervals, less frequent screening intervals of every 6 months compared to every 3 months for the first three years using CT resulted in an ICER of $690,527/QALY and for CXR, the ICER was $271,423/QALY. In comparing screening duration between 6 years and 10 years of follow-up, strategies with longer follow-up resulted in slightly higher QALYs in each of the comparison scenarios, at a much higher cost. Conclusions: In our evaluation, more frequent screening the first 3 years and longer duration of surveillance resulted in higher QALYs in both screening modalities. However, in the comparisons the ICERs exceed common willingness to pay thresholds of $150,000/QALY gained; CXR is the more cost-effective imaging modality. Limitation of this model includes the simplification of disease progression and heterogeneity in STS.

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