MPS  Vol.3 No.4 , October 2013
Single Stage Oncologic Resection and Reconstruction: A Step toward Development of Sarcoma Service in Resource Constrained Country
ABSTRACT

Tumor free-margin surgical resection remains the single most important treatment in the curative therapy of musculoskeletal tumor of limbs. Refinements in surgical techniques have led to increased function preservation and limb salvage. Patients and Methods: The records of patients (n = 24) who underwent microsurgical soft tissue reconstruction subsequent to resection of limb tumour during the period 2006 to 2011 were reviewed. Primary outcome i.e. uptake of the flap was evaluated. Perioperative morbidities were also noted including donor as well as recipient site complications. Assessment of Functional outcome (Musculoskeletal Tumor Society score, MSTS) local recurrence, free survival, and disease-specific survival was also made. Results: Twenty four patients (age range: 7 - 72 years) who have undergone tumor resection followed by flap coverage were identified. Lower limb reconstruction outnumbered upper limb by 6:1. Complications included, one complete failure of free vascularized iliac crest flap done for reconstruction of a heel defect. One of the patients had secondary hemorrhage 10 days after surgery. Another patient with internal hemipelvectomy for Ewing’s sarcoma had a dura puncture during resection of sacrum. Partial epidermal necrosis was evident in four cases. Eighty three percent of the patients remained alive (n = 20), 19 of whom currently have no evidence of disease (NED) Disease recurrence was noted in three patients. Overall MSTS score was 73.5%. Conclusion: The microsurgical repair of defects is a reliable option that, though not free of complications, is necessary in selected cases. The procedure enables both adequate oncosurgical resection and function preservation.


Cite this paper
H. Rashid, K. Abbas and M. Umer, "Single Stage Oncologic Resection and Reconstruction: A Step toward Development of Sarcoma Service in Resource Constrained Country," Modern Plastic Surgery, Vol. 3 No. 4, 2013, pp. 134-141. doi: 10.4236/mps.2013.34028.
References
[1]   S. A. Rosenberg, J. Tepper, E. Glatstein, et al., “The Treatment of Soft-Tissue Sarcomas of the Extremities: Prospective Randomized Evaluations of 1) Limb-Sparing Surgery plus Radiation Therapy Compared with Amputation and 2) the Role of Adjuvant Chemotherapy,” Annals of Surgery, Vol. 196, No. 3, 1982, pp. 305-315. http://dx.doi.org/10.1097/00000658-198209000-00009

[2]   J. C. Yang, A. E. Chang, A. R. Baker, et al., “Randomized Prospective Study of the Benefit of Adjuvant Radiotherapy in the Treatment of Soft Tissue Sarcomas of the Extremity,” Journal of Clinical Oncology, Vol. 16, No. 1, 1998, pp. 197-203.

[3]   M. A. Clark, C. Fisher, I. Judson and J. M. Thomas, “Soft-Tissue Sarcomas in Adults,” New England Journal of Medicine, Vol. 353, 2005, pp. 701-711. http://dx.doi.org/10.1056/NEJMra041866

[4]   M. A. Clark and J. M. Thomas, “Amputation for Soft-Tissue Sarcoma,” Lancet Oncology, Vol. 4, No. 6, 2003, pp. 335-342. http://dx.doi.org/10.1016/S1470-2045(03)01113-6

[5]   M. A. Clark and J. M. Thomas, “Major Amputation for Soft-Tissue Sarcoma,” British Journal of Surgery, Vol. 90, No. 1, 2003, pp. 102-107. http://dx.doi.org/10.1002/bjs.4004

[6]   J. M. Serletti, A. J. Carras, R. J. O’Keefe and R. N. Rosier, “Functional Outcome after Soft-Tissue Reconstruction for Limb Salvage after Sarcoma Surgery,” Plastic and Reconstructive Surgery, Vol. 102, No. 5, 1998, pp. 1576-1583. http://dx.doi.org/10.1097/00006534-199810000-00036

[7]   I. A. Kramers-de Quervain, J. M. Lauffer, K. Kach, O. Trentz and E. Stüssi, “Functional Donor-Site Morbidity during Level and Uphill Gait after a Gastrocnemius or Soleus Muscle-Flap Procedure,” The Journal of Bone and Joint Surgery (American Volume), Vol. 83, No. A2, 2001, pp. 239-246.

[8]   T. Liu, Q. Zhang, X. Zhang, Z. Li, Y. Shen, X. Guo and L. Ling, “Medial Head Gastrocnemius Muscle Flap in the Limb-Salvage Operation for Proximal Tibial Osteosarcoma,” Journal of Central South University. Medical Sciences, Vol. 37, No. 12, 2012, pp. 1250-1254.

[9]   S. V. Deo, K. S. Nootan, B. Niranjan and K. Dinesh, “Vertical Rectus Abdominis Myocutaneous Flap Cover for Lower Abdomen, Chest Wall, Groin and Thigh Defects Following Resection of Malignant Tumours,” Indian Journal of Cancer, Vol. 38, No. 1, 2001, pp. 33-37.

[10]   B. S. Glatt, J. J. Disa, B. J. Mehrara, A. L. Pusic, P. Boland and P. G. Cordeiro, “Reconstruction of Extensive Partial or Total Sacrectomy Defects with Transabdominal Vertical Rectus Abdomnis Myocutaneous Flap,” Annals of Plastic Surgery, Vol. 56, No. 5, 2006, pp. 526-530.
http://dx.doi.org/10.1097/01.sap.0000205772.15061.39

[11]   T. Morii, M. Susa, R. Nakayama, K. Kishi, H. Morioka and H. Yabe, “Reconstruction Modality Based on the Spare Part Concept for Massive Soft Tissue Defects Following Oncological Hemipelvectomy,” Journal of Orthopaedic Science, Vol. 14, No. 2, 2009, pp. 192-197. http://dx.doi.org/10.1007/s00776-008-1316-5

[12]   M. V. Küntscher, D. Erdmann, H. H. Homann, H. U. Steinau, S. L. Levin and G. Germann, “The Concept of Fillet Flaps: Classification, Indications, and Analysis of Their Clinical Value,” Plastic and Reconstructive Surgery, Vol. 108, No. 4, 2001, pp. 885-896. http://dx.doi.org/10.1097/00006534-200109150-00011

[13]   S. M. Walsh, S. G. Fisher and R. A. Sage, “Survival of Patients with Primary Pedal Melanoma,” Journal of Foot and Ankle Surgery, Vol. 42, No. 4, 2003, pp. 193-198. http://dx.doi.org/10.1016/S1067-2516(03)70028-3

[14]   R. Niimi, A. Matsumine, T. Hamaguchi, T. Nakamura, A. Uchida and A. Sudo, “Prosthetic Limb Salvage Surgery for Bone and Soft Tissue Tumors around the Knee,” Oncology Reports, Vol. 28, No. 6, 2012, pp. 1984-1990.

[15]   J. Li, Z. Wang, Z. Guo, M. Yang, G. Chen and G. Pei, “Composite Biological Reconstruction Following Total Calcanectomy of Primary Calcaneal Tumors,” Journal of Surgical Oncology, Vol. 105, No. 7, 2012, pp. 673-678. http://dx.doi.org/10.1002/jso.23022

[16]   C. E. Payne, S. O. Hofer, T. Zhong, A. C. Griffin, P. C. Ferguson and J. S. Wunder, “Functional Outcome Following upper Limb Soft Tissue Sarcoma Resection with Flap Reconstruction,” Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 66, No. 5, 2013, pp. 601-607. http://dx.doi.org/10.1016/ j.bjps.2013.01.034

[17]   P. T. Funovics, F. Bucher, C. D. Toma, R. I. Kotz and M. Dominkus, “Treatment and Outcome of Parosteal Osteosarcoma: Biological versus Endoprosthetic Reconstruction,” Journal of Surgical Oncology, Vol. 103, No. 8, 2011, pp. 782-789. http://dx.doi.org/10.1002/jso.21859

 
 
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