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Hassan AM, Tesfaye EA, Rashiwala A, Roubaud MJ, Mericli AF. Functional Muscle Transfer after Oncologic Extremity Resection. J Reconstr Microsurg 2023; 39:195-208. [PMID: 35768008 DOI: 10.1055/a-1887-7530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Functional muscle transfer (FMT) can provide wound closure and restore adequate muscle function for patients with oncologic extremity defects. Herein we describe our institutional experience with FMT after oncological resection and provide a systematic review and meta-analysis of the available literature on this uncommon procedure. METHODS A single-institution retrospective review was performed, including all patients who received FMT after oncological resection from 2005 to 2021. For the systematic review and meta-analysis, PubMed, Cochrane, Medline, and Embase libraries were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; results were pooled, weighted by study size, and analyzed. RESULTS The meta-analysis consisted of seven studies with 70 patients overall, demonstrating a mean Medical Research Council (MRC) score of 3.78 (95% confidence interval: 2.97-4.56; p < 0.01). The systematic review included 28 studies with 103 patients. Receipt of adjuvant chemotherapy was associated with significantly lower mean MRC score (3.00 ± 1.35 vs. 3.90 ± 1.36; p = 0.019). Seventy-four percent of the patients underwent free FMT, with the most common donor muscle being the latissimus dorsi (55%). The flap loss rate was 0.8%. Neoadjuvant chemotherapy (p = 0.03), radiotherapy (p = 0.05), pedicled FMTs (p = 0.01), and a recipient femoral nerve (p = 0.02) were associated with significantly higher complication rates. The institutional retrospective review identified 13 patients who underwent FMT after oncological resection with a median follow-up time of 21 months (range: 6-74 months). The most common tumor necessitating FMT was undifferentiated pleomorphic sarcoma (77%), and the most common donor muscle was the latissimus dorsi (62%). A high body mass index was associated with prolonged neuromuscular recovery (R = 0.87, p = 0.002). CONCLUSION FMT after oncological resection may contribute to improved extremity function. Careful consideration of risk factors and preoperative planning is imperative for successful FMT outcomes.
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Affiliation(s)
- Abbas M Hassan
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eliora A Tesfaye
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Abhi Rashiwala
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Margaret J Roubaud
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander F Mericli
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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One-Step Lower Leg Reconstruction with Vascularized Functional Vastus Lateralis Muscle Flap in the Treatment of Embryonal Rhabdomyosarcoma for a Six-Month-Old Boy: A Case Report. ACTA ACUST UNITED AC 2020; 56:medicina56070362. [PMID: 32708209 PMCID: PMC7404637 DOI: 10.3390/medicina56070362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
Rhabdomyosarcoma (RMS) is a common soft tissue sarcoma in childhood, however, it is very rare in the neonatal period (0.4-2% of cases). This case depicts a boy, who presented with RMS at two weeks of age, but officially diagnosed at the age of three months. MRI and scintigraphy determined a soft tissue tumor in the soleus muscle, while biopsy confirmed embryonal RMS with high mitotic activity (Ki67 (monoclonal antibodies) ~80%). CWS (Cooperative Weichteilsarkom Studiengruppe)-2012 with I2VA (ifosfamide, vincristine, actinomycin) chemotherapy regimen was administered per protocol. Surgical treatment was performed at age of six months and 18 days. The operation consisted of radical tumor resection and total triceps surae with partial fibula resection. Immediate reconstruction of triceps muscle was accomplished using a vascularized functional musculocutaneous vastus lateralis flap. Functional outcome was measured using the Lower Extremity Functional Scale (LEFS) and the Foot and Ankle Outcome Score (FAOS) with the results of 92.5% and 99% respectively.
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Stranix JT, Lee ZH, Lam G, Mirrer J, Rapp T, Saadeh PB. Limb-sparing sarcoma reconstruction with functional composite thigh flaps. Microsurgery 2017; 38:466-472. [DOI: 10.1002/micr.30254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 08/26/2017] [Accepted: 09/18/2017] [Indexed: 12/29/2022]
Affiliation(s)
- John T. Stranix
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
| | - Z-Hye Lee
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
| | - Gretl Lam
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
| | - Joshua Mirrer
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
| | - Timothy Rapp
- Department of Orthopedic Surgery; NYU Langone Medical Center; New York NY
| | - Pierre B. Saadeh
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
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Free Neurovascular Latissimus Dorsi Muscle Transplantation for Reconstruction of Hip Abductors. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1498. [PMID: 29062663 PMCID: PMC5640369 DOI: 10.1097/gox.0000000000001498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Resection of tumors affecting the hip abductors can cause significant decrease in muscle strength and may lead to abnormal gait and poor function. We present a case report showing full functional recovery after resection of a synovial sarcoma affecting the right gluteus medius and minimus muscles with reconstruction free neurovascular latissimus dorsi muscle transplantation. The latissimus dorsi muscle was harvested following standard technique and fixed to the ilium and the greater trochanter. Receptor vessels were end-to-end anastomosed to the subscapular vessels followed by an end-to-end epineural suture between the superior gluteal nerve and the thoracodorsal nerve. A year after surgery, there is no evidence of recurrent disease; electromyographic analysis shows complete reinnervation of the latissimus dorsi muscle flap, and the patient has achieved full functional recovery. Free functional latisimus dorsi transfer could be considered as a viable reconstruction technique after hip abductors resection in tumor surgery.
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Baker HB, Passipieri JA, Siriwardane M, Ellenburg MD, Vadhavkar M, Bergman CR, Saul JM, Tomblyn S, Burnett L, Christ GJ. Cell and Growth Factor-Loaded Keratin Hydrogels for Treatment of Volumetric Muscle Loss in a Mouse Model. Tissue Eng Part A 2017; 23:572-584. [PMID: 28162053 DOI: 10.1089/ten.tea.2016.0457] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Wounds to the head, neck, and extremities have been estimated to account for ∼84% of reported combat injuries to military personnel. Volumetric muscle loss (VML), defined as skeletal muscle injuries in which tissue loss results in permanent functional impairment, is common among these injuries. The present standard of care entails the use of muscle flap transfers, which suffer from the need for additional surgery when using autografts or the risk of rejection when cadaveric grafts are used. Tissue engineering (TE) strategies for skeletal muscle repair have been investigated as a means to overcome current therapeutic limitations. In that regard, human hair-derived keratin (KN) biomaterials have been found to possess several favorable properties for use in TE applications and, as such, are a viable candidate for use in skeletal muscle repair. Herein, KN hydrogels with and without the addition of skeletal muscle progenitor cells (MPCs) and/or insulin-like growth factor 1 (IGF-1) and/or basic fibroblast growth factor (bFGF) were implanted in an established murine model of surgically induced VML injury to the latissimus dorsi (LD) muscle. Control treatments included surgery with no repair (NR) as well as implantation of bladder acellular matrix (BAM). In vitro muscle contraction force was evaluated at two months postsurgery through electrical stimulation of the explanted LD in an organ bath. Functional data indicated that implantation of KN+bFGF+IGF-1 (n = 8) enabled a greater recovery of contractile force than KN+bFGF (n = 8)***, KN+MPC (n = 8)**, KN+MPC+bFGF+IGF-1 (n = 8)**, BAM (n = 8)*, KN+IGF-1 (n = 8)*, KN+MPCs+bFGF (n = 9)*, or NR (n = 9)**, (*p < 0.05, **p < 0.01, ***p < 0.001). Consistent with the physiological findings, histological evaluation of retrieved tissue revealed much more extensive new muscle tissue formation in groups with greater functional recovery (e.g., KN+IGF-1+bFGF) when compared with observations in tissue from groups with lower functional recovery (i.e., BAM and NR). Taken together, these findings further indicate the general utility of KN biomaterials in TE and, moreover, specifically highlight their potential application in the treatment of VML injuries.
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Affiliation(s)
- H B Baker
- 1 Fischell Department of Bioengineering, University of Maryland , College Park, Maryland.,2 Wake Forest Institute for Regenerative Medicine, Wake Forest University , Winston-Salem, North Carolina
| | - J A Passipieri
- 2 Wake Forest Institute for Regenerative Medicine, Wake Forest University , Winston-Salem, North Carolina.,3 Department of Biomedical Engineering, University of Virginia , Charlottesville, Virginia
| | - Mevan Siriwardane
- 2 Wake Forest Institute for Regenerative Medicine, Wake Forest University , Winston-Salem, North Carolina
| | | | - Manasi Vadhavkar
- 2 Wake Forest Institute for Regenerative Medicine, Wake Forest University , Winston-Salem, North Carolina
| | - Christopher R Bergman
- 2 Wake Forest Institute for Regenerative Medicine, Wake Forest University , Winston-Salem, North Carolina
| | - Justin M Saul
- 5 Department of Chemical, Paper and Biomedical Engineering, Miami University , Oxford, Ohio
| | - Seth Tomblyn
- 4 KeraNetics, LLC , Winston-Salem, North Carolina
| | - Luke Burnett
- 4 KeraNetics, LLC , Winston-Salem, North Carolina
| | - George J Christ
- 2 Wake Forest Institute for Regenerative Medicine, Wake Forest University , Winston-Salem, North Carolina.,3 Department of Biomedical Engineering, University of Virginia , Charlottesville, Virginia.,6 Department of Orthopaedics, University of Virginia , Charlottesville, Virginia
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Arteau A, Seeli F, Fuchs B. Complete deltoid resection in early childhood without muscle transfer results in normal shoulder function at long-term follow-up: a case report. J Med Case Rep 2017; 11:13. [PMID: 28086945 PMCID: PMC5237155 DOI: 10.1186/s13256-016-1132-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 11/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal tumors involving the deltoid muscle and necessitating its complete resection are rare. The function after complete deltoid resection is reported to be limited, and several authors consider muscle transfer to improve shoulder motion. However, it still remains unclear whether such transfer adds function. To the best of our knowledge, all reports on complete deltoid resection refer to adult patients, and it is unknown what function results after deltoid resection in childhood. The remaining muscles may have the potential to compensate for the loss of deltoid function. CASE PRESENTATION Here we report the case of a 5-year-old white boy with complete (isolated) deltoid muscle resection in infancy for a large aggressive soft tissue tumor. No reconstructive procedure or muscle transfer was performed at the time of index surgery. Pathology revealed an angiomatoid fibrous histiocytoma. His postoperative course was uneventful. At 11 years of follow-up, he remained disease-free and had excellent shoulder function, including normal range of motion. CONCLUSIONS This report implies that major muscles such as the deltoid can be resected in a child without compromising long-term function. Therefore, a muscle transfer at index surgery is probably not necessary.
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Affiliation(s)
- Annie Arteau
- Hôtel Dieu de Québec, 11 Côte du Palais, Quebec, G1R 2J6, Canada
| | - Franziska Seeli
- Sarkomzentrum UZH, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Bruno Fuchs
- Sarkomzentrum UZH, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
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Fischer S, Soimaru S, Hirsch T, Kueckelhaus M, Seitz C, Lehnhardt M, Goertz O, Steinau HU, Daigeler A. Local tendon transfer for knee extensor mechanism reconstruction after soft tissue sarcoma resection. J Plast Reconstr Aesthet Surg 2015; 68:729-35. [PMID: 25656337 DOI: 10.1016/j.bjps.2015.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 12/12/2014] [Accepted: 01/09/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Aim of this study was to measure the outcome of hamstring transfer for quadriceps reconstruction after soft tissue sarcoma resection and to identify risk factors influencing postoperative results. METHODS 43 patients underwent hamstring transfer after sarcoma resection. Medical records were reviewed for surgical technique and complications. Physical examination included assessment of range of motion and muscle strength as well as plantar pressure distribution by computerized dynamometer and podometry, respectively. Additionally, patients' satisfaction, quality of life and karnofsky index were assessed. RESULTS Sole biceps transfer was performed in 31 (74%) and combined biceps/semitendinosus or gracilis transfer in 12 patients (26%). In 91%of cases 3/4 or more of the quadriceps muscle had to be removed. Postoperative complications occurred in 16 patients (37%). 17 patients (40%) were available for physical examination. Mean follow-up was 61 months (22-107). Average knee flexion was 74° (35-110°). All patients had full knee extension. Average extension force was 44% (19-79%) and flexion-force 74% (55-100%) of the unaffected leg. Mean plantar pressure distribution was 119% (44-200%) on the forefoot and 107% (60-169%) on the heel. Average patient satisfaction score was 16 (9-25), quality of life assessment was 78 (54-92) and Karnofsky Index was 82% (70-90%). Besides patient's age and the extent of resection, the surgical technique had statistically significant influence on functional outcome and postoperative complications (p < 0.05). CONCLUSION Hamstring transfer is feasible for quadriceps reconstruction after massive tumor resection from the thigh. In contrast to biceps alone, combined semitendinosus or gracilis transfer revealed comparable outcome but higher complication rates.
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Affiliation(s)
- Sebastian Fischer
- BG Trauma Center Ludwigshafen - Department of Hand-Plastic and Reconstructive Surgery, Burn Center, University of Heidelberg, Germany
| | - Silke Soimaru
- BG University Hospital Bergmannsheil - Department of Plastic and Reconstructive Surgery, Burn Center, Ruhr University Bochum, Germany
| | - Tobias Hirsch
- BG University Hospital Bergmannsheil - Department of Plastic and Reconstructive Surgery, Burn Center, Ruhr University Bochum, Germany
| | - Maximilian Kueckelhaus
- BG University Hospital Bergmannsheil - Department of Plastic and Reconstructive Surgery, Burn Center, Ruhr University Bochum, Germany
| | - Christoph Seitz
- University Children's Hospital Heidelberg - Department of Neonatology, Heidelberg, Germany
| | - Marcus Lehnhardt
- BG University Hospital Bergmannsheil - Department of Plastic and Reconstructive Surgery, Burn Center, Ruhr University Bochum, Germany
| | - Ole Goertz
- BG University Hospital Bergmannsheil - Department of Plastic and Reconstructive Surgery, Burn Center, Ruhr University Bochum, Germany
| | - Hans-Ulrich Steinau
- University Clinic Essen - Tumor Center of West-Germany/Sarcoma Centre, University of Essen, Germany
| | - Adrien Daigeler
- BG University Hospital Bergmannsheil - Department of Plastic and Reconstructive Surgery, Burn Center, Ruhr University Bochum, Germany.
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Abstract
The treatment of musculoskeletal sarcomas has made vast strides in the last few decades. From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality, the unique challenges of reconstruction in skeletally immature individuals and the impact of adjuvant modalities like chemotherapy and radiotherapy on surgical outcomes are also discussed.
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Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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