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Kreutz-Rodrigues L, Weissler JM, Moran SL, Carlsen BT, Mardini S, Houdek MT, Rose PS, Bakri K. Reconstruction of complex hemipelvectomy defects: A 17-year single-institutional experience with lower extremity free and pedicled fillet flaps. J Plast Reconstr Aesthet Surg 2019; 73:242-254. [PMID: 31703941 DOI: 10.1016/j.bjps.2019.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/31/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Hemipelvectomy procedures result in massive soft tissue defects. The standard approach is to reconstruct the defect with anterior or posterior hemipelvectomy flaps. Certain situations preclude the use of local tissue flaps, and an alternative is the use of leg fillet flaps, circumferential pedicled or free flaps harvested from the amputated part. The purpose of this study is to present our institution's experience with using pedicled and free fillet flaps to reconstruct hemipelvectomy soft tissue defects. METHODS We performed a retrospective chart review of patients who underwent hemipelvectomy and fillet flap reconstruction from 2001 to 2018. Demographics, clinical and surgical characteristics, postoperative outcomes, and complications of patients were reviewed. RESULTS Ten patients were identified and included. Their mean age was 51 ± SD 12.4 years. Six patients underwent standard external hemipelvectomy and 4 patients underwent extended external hemipelvectomy. Seven lower extremity fillet flaps were performed as free tissue transfers, and 3 were pedicled flaps. The mean flap size was 1,153 ± SD 1137 cm2. The mean follow-up was 5 months (range: 1-24 months). Five patients developed postoperative complications; none of them required operative intervention. There were no partial or total flap losses postoperatively. CONCLUSION Reconstruction with pedicled or free lower extremity fillet flaps is a valuable reconstructive approach, for managing large soft tissue defects following hemipelvectomy when the standard anterior and posterior thigh flaps are unavailable or inadequate for complete soft tissue coverage. This useful technique mitigates donor site morbidity, while simultaneously achieving massive soft tissue coverage with an acceptable complication profile.
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Affiliation(s)
- Lucas Kreutz-Rodrigues
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Jason M Weissler
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Steven L Moran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Brian T Carlsen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Samir Mardini
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Karim Bakri
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
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Limb-Salvage Surgery of Soft Tissue Sarcoma with Sciatic Nerve Involvement. Sarcoma 2018; 2018:6483579. [PMID: 29692655 PMCID: PMC5859890 DOI: 10.1155/2018/6483579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/08/2018] [Indexed: 12/20/2022] Open
Abstract
Background The surgical resection of soft tissue sarcomas (STS) with sciatic nerve involvement presents a significant surgical and oncological challenge. Current treatment strategies pursue a multimodal approach with the aim of limb preservation. We aim to evaluate the outcomes of limb-sparing surgery of STS in a patient cohort and to propose a classification for STS with sciatic nerve involvement. Methods Patients receiving limb-preserving resections for STS with sciatic nerve involvement between 01/2010 and 01/2017 were included. Clinical and oncological data were prospectively collected in a computerized database and retrospectively analyzed. Sciatic nerve involvement in STS was classified preoperatively as follows: type A for nerve encasement; type B for nerve contact; and type C for no nerve involvement. Results A total of 364 patients with STS were treated, of which 27 patients had STS with sciatic nerve involvement. Eight patients with type A tumors (29.6%) underwent sciatic nerve resection, and 19 patients with type B tumors (70.4%) received epineural dissections. Disease progression was observed in 8 patients (29.6%) with a local recurrence of 11.1% and distant metastasis in 29.6%. The type of nerve resection significantly influenced leg function but had no impact on disease recurrence or overall survival. Conclusion In a cohort of carefully selected patients with STS and sciatic nerve involvement, the extent of sciatic nerve resection had no significant impact on disease recurrence or survival. Precise classification of neural involvement may therefore be useful in selecting the appropriate degree of nerve resection, without compromising oncological outcome or unnecessarily sacrificing leg function.
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Alamanda V, Crosby S, Archer K, Song Y, Schwartz H, Holt G. Amputation for extremity soft tissue sarcoma does not increase overall survival: A retrospective cohort study. Eur J Surg Oncol 2012; 38:1178-83. [DOI: 10.1016/j.ejso.2012.08.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/23/2012] [Indexed: 01/22/2023] Open
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Cata JP, Gottumukkala V. Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know? ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/918938] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with solid malignancies who were not candidates for tumor resections in the past are now presenting for extensive oncological resections. Cancer patients are at risk for thromboembolic complications due to an underlying hypercoagulable state; however, some patients may have an increased risk for bleeding due to the effects of chemotherapy, the administration of anticoagulant drugs, tumor-related fibrinolysis, tumor location, tumor vascularity, and extent of disease. A common potential complication of all complex oncological surgeries is massive intra- and postoperative hemorrhage and the subsequent risk for massive blood transfusion. This can be anticipated or unexpected. Several surgical and anesthesia interventions including preoperative tumor embolization, major vessel occlusion, hemodynamic manipulation, and perioperative antifibrinolytic therapy have been used to prevent or control blood loss with varying success. The exact incidence of massive blood transfusion in oncological surgery is largely unknown and/or underreported. The current literature mostly consists of purely descriptive observational studies. Thus, recommendation regarding specific perioperative intervention cannot be made at this point, and more research is warranted.
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Affiliation(s)
- Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 409, Houston, TX 77030, USA
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 409, Houston, TX 77030, USA
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Mat Saad AZ, Halim AS, Faisham WI, Azman WS, Zulmi W. Soft tissue reconstruction following hemipelvectomy: eight-year experience and literature review. ScientificWorldJournal 2012; 2012:702904. [PMID: 22629187 PMCID: PMC3353558 DOI: 10.1100/2012/702904] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/08/2011] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives. Hemipelvectomy is a major surgical procedure that associates with significant morbidity, functional impairment, and psychological and body image problem. Reconstruction of the defect is a challenged since a large amount of composite tissues are needed. We would like to share our eight-year experience with massive pelvic resection and reconstruction.
Methods. A retrospective analysis of all cases of hemipelvectomy was conducted in our institution over eight-year period with particular attention given to the reconstruction choices and associated complications. Results. Thirteen patients were included with median age of 39 years (range 13–78) of which all had advanced tumour with stage IIb (54%) and Stage III (46%). External hemipelvectomy was performed in all cases, and resultant defects were reconstructed with variety type of flaps. These include fillet thigh flaps, regional pedicle flaps of different designs, and free flap. Conclusions. Massive pelvic tumour is rarely encountered in our population but can be seen across all age groups and usually due to late presentation. The defects should be reconstructed using local or regional flaps, incorporating the muscle component to enhance flap perfusion. The tissue should be harvested from the amputated limb, as it can limit the donor site morbidity.
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Affiliation(s)
- A Z Mat Saad
- Reconstructive Sciences Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia.
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Jawad MU, Haleem AA, Scully SP. Malignant sarcoma of the pelvic bones: treatment outcomes and prognostic factors vary by histopathology. Cancer 2010; 117:1529-41. [PMID: 21425154 DOI: 10.1002/cncr.25684] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/19/2010] [Accepted: 09/07/2010] [Indexed: 11/05/2022]
Abstract
BACKGROUND Treatment of malignant sarcomas of the pelvis poses a challenge for local disease control and oncologic outcome. Many reports have described the dismal outcomes. Most studies are retrospective series coming out of single centers, thus biased toward patient selection and are of limited statistical power. METHODS The authors used the Surveillance, Epidemiology, and End Results database to analyze 1185 pelvic sarcoma cases from 1987 to 2006. Kaplan-Meier and Cox regression were used to analyze the significance of prognostic factors. The analysis was repeated for different histopathological subtypes to determine specific prognostic factors in each case. RESULTS Incidence of pelvic sarcoma in 2006 was 89 per 100,000 persons; it has significantly increased since 1973 (P < .05). The overall 5-year survival for all the patients with pelvic sarcoma was 47%, with osteosarcoma having the worst 5-year survival at 19% and patients with chordoma having the best 5-year survival at 60%. Independent prognostic factors included age, stage, grade, size of primary lesion, histopathology, and treatment-related factors. Comparing the patients only with high-grade lesions, patients with Ewing sarcoma have the best prognosis. CONCLUSIONS This is an analysis of patients with pelvic sarcomas derived from a population-based registry. Survival and prognostics vary with histopathological diagnoses. Although surgical resection was associated with superior outcomes for osteosarcoma and chondrosarcoma, there was no significant difference in outcomes of patients with Ewing sarcoma treated with surgery and/or radiotherapy.
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Affiliation(s)
- Muhammad Umar Jawad
- Department of Orthopedics, Stanford University Hospital and Clinics, Stanford, California 94301, USA.
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Ziran BH, Smith WR, Rao N. Hemipelvic amputations for recalcitrant pelvic osteomyelitis. Injury 2008; 39:411-8. [PMID: 18321513 DOI: 10.1016/j.injury.2007.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 10/29/2007] [Accepted: 12/03/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the outcome of recalcitrant deep pelvic infection that required a hemipelvic amputation. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral centre; Level I trauma. PATIENTS There were 20 patients with an infection of the pelvic girdle who developed life-threatening sepsis or had an intolerable existence due to putrefied tissues that prevented end of life care. All patients failed other more conservative treatments such as limited debridement and local wound care. The indication for amputation was life-threatening sepsis (eight patients), intolerable state with putrid tissue (four patients), and both sepsis/putrefaction (eight patients). INTERVENTION A hemipelvic amputation, multidrug antibiotic treatment, and long-term suppression. Ten internal hemipelvectomies, eight external hemipelvectomies, and two hemicorporectomies were performed. MAIN OUTCOME MEASURE Survival and recurrence of infection. RESULTS Six patients died within 6 months (mean time 17 weeks, range 2-24). The 14 surviving patients had a mean follow-up time of 28 weeks (9-48). Of these, 10 patients survived with no evidence of ongoing infection, and four patients had ongoing infection requiring suppressive antibiotics. All of the six deaths were in C-hosts with an average of six comorbidities each; mean age was 62 years old. Aetiologies of the infection were vasculopathy (5), spinal cord injury (4), post fracture (3), post abdominal surgery (2), gunshot wound (2), seeding from bacteraemia (4). Cierny-Mader host class was C (11) and B systemic/local (9) with an average of four (4) comorbidities each. Mean estimated blood loss=3100 cc and operative time=157 min. There were 11 cases of minor wound problems and no flap loss. Pathogens were polymicrobial (16 total pathogens) with mean of three per patient (most common was MRSA). Multi-agent antibiotic and suppression were used in all patients. In cases with putrefied tissues, appropriate nursing care was possible. CONCLUSION Patients requiring hemipelvectomies usually present with sepsis or an intolerable state. Despite expected complications, we found that hemipelvectomy is an effective palliative tool in selected cases. Age and vascular disease seemed to be associated with worse outcomes.
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Affiliation(s)
- Bruce H Ziran
- Department of Orthopaedic Trauma, St. Elizabeth Health Center, Northeast Ohio Universities College of Medicine, Youngstown, OH 44501, United States.
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Senchenkov A, Moran SL, Petty PM, Knoetgen J, Clay RP, Bite U, Barnes SA, Sim FH. Predictors of Complications and Outcomes of External Hemipelvectomy Wounds: Account of 160 Consecutive Cases. Ann Surg Oncol 2007; 15:355-63. [PMID: 17955297 DOI: 10.1245/s10434-007-9672-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 09/21/2007] [Accepted: 09/25/2007] [Indexed: 11/18/2022]
Affiliation(s)
- Alex Senchenkov
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
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Affiliation(s)
- John M Kane
- Department of Surgical Oncology-Melanoma/Sarcoma, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
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Mankin HJ, Hornicek FJ. Internal hemipelvectomy for the management of pelvic sarcomas. Surg Oncol Clin N Am 2005; 14:381-96. [PMID: 15817245 DOI: 10.1016/j.soc.2004.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Henry J Mankin
- Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Gray 6 Orthopaedics, Boston, 02114, USA.
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Abstract
This is a report of outcomes after a review of the demographic, diagnostic, therapeutic, and survival data for patients with pelvic primary and secondary tumors treated during the past 28 years. Using a computerized system it has been possible to assess the results for 206 patients with bone and soft tissue sarcomas and metastatic carcinomas to define the variation in outcome and the factors which statistically show an effect on survival. The data were compared with data for other anatomic sites. Based on our study, it is apparent that the outcome for all the tumors was approximately 50% survival with only soft tissue sarcomas having a poorer result. There were only minimal to moderate differences in outcome on the basis of gender, age, type of surgery, or adjunctive therapy. Patients who had intralesional surgery did less well as did patients with higher Musculoskeletal Tumor Society stages. Comparing the results for these patients with results for patients with the same stage and diagnosis but with tumors located in other sites showed significant differences. Results for patients with pelvic allograft compared with results of patients who had femoral allografts for the same diagnoses showed a poorer outcome for the patients who had pelvic allografts. Several possible explanations are provided for these variations in results.
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Affiliation(s)
- Henry J Mankin
- Orthopaedic Oncology Service, Gray 6 Orthopedics, Massachusetts General Hospital and Children's Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Abstract
Soft-tissue sarcomas are a group of rare malignant tumours, many of which arise in the limbs. Most are treated with a combination of wide local excision and radiotherapy, but a small number--including proximal, large, high-grade, or recurrent tumours, or those involving major neurovascular structures--necessitate major amputation including forequarter or hindquarter amputation. These uncommon operations should remain in the surgical armamentarium for carefully selected patients. Those being considered for amputation should be referred to a tertiary sarcoma unit for examination of all other options, such as limb-salvage surgery, tumour downstaging with chemotherapy or radiotherapy (perhaps with subsequent limb-salvage surgery), or novel techniques such as isolated limb perfusion. Only after careful assessment should amputation be carried out. Outcomes after major amputation are highly variable, but such procedures can confer useful palliation to patients with distressing symptoms (pain, bleeding, fungation), long-term disease-free survival with reasonable function in carefully selected patients, and cure in some.
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Affiliation(s)
- Matthew A Clark
- Department of Surgery, Middlemore Hospital, Auckland, New Zealand
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Hagiwara Y, Hatori M, Kokubun S, Miyasaka Y. Gait characteristics of sciatic nerve palsy--a report of four cases. Ups J Med Sci 2003; 108:221-7. [PMID: 15000460 DOI: 10.3109/2000-1967-116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are few reports concerning the gait characteristics of sciatic nerve palsy. Four cases, one with complete palsy and three with incomplete palsy, are presented. Complete palsy (case 1) was due to sacrifice of the sciatic nerve in a wide excision for chondrosarcoma in the left ischium. Incomplete palsy (cases 2, 3, and 4) was due to contusion incurred in traffic accidents. It is noteworthy that all four patients could walk with or without a short-leg brace. But the patients with complete loss of proprioception distal to the ankle (cases 1 and 2) had to watch their steps while walking to maintain their walking balance. This clinical analysis revealed that proprioceptive impairment of the sciatic nerve caused a walking disability even though the palsy was incomplete.
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Affiliation(s)
- Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Japan 980-8574
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Abstract
BACKGROUND Advances in oncological practice have reduced the number of major amputations performed for soft-tissue sarcoma, but this remains a valuable, if infrequent, option for both curative and palliative indications. METHODS A review of patients and case-notes was carried out from the prospective sarcoma database at the Royal Marsden Hospital. RESULTS Over a 10-year interval, 40 major amputations (18 forequarter, 17 hindquarter and five through hip) were performed, predominantly for disease recurring after previous limb-conserving surgery (31 of 40). A wide variety of soft-tissue sarcoma subtypes was seen; they were often large (more than 10 cm; 18 of 40) or multifocal (six), usually high grade (25), and frequently proximal or involving neurovascular structures such that limb salvage was precluded. Median range age of the patients was 59 (17-87) years. The operative 30-day mortality rate was zero. Hospital stay was a median of 10.5 days for forequarter amputation, and 19 days for hindquarter and through-hip amputation. Local recurrence occurred in ten patients, six of whom had concurrent distant metastases. Twenty-seven patients were alive (20 disease free) at a median follow-up of 12 months, nine of whom were alive without evidence of disease beyond 2 years. Ten patients died after a median of 7.5 months; three survived more than 2 years. CONCLUSION Major amputation is a useful procedure in carefully selected patients with soft-tissue sarcoma.
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Affiliation(s)
- M A Clark
- Melanoma and Sarcoma Unit, Royal Marsden Hospital, Fulham Road, Chelsea, London SW3 6JJ, UK
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Kim CJ, Puleo C, Letson GD, Reintgen D. Hyperthermic isolated limb perfusion for extremity sarcomas. Cancer Control 2001; 8:269-73. [PMID: 11378653 DOI: 10.1177/107327480100800307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The treatment options available for extremity sarcomas are amputation or limb-sparing surgery with radiation, which may incur significant morbidity and body disfigurement. Hyperthermic isolated limb perfusion (HILP) may be an attractive option in extremity sarcomas for unresectable lesions to preserve limb function and maintain quality of life. METHODS We report the outcomes of 5 patients who underwent HILP for unresectable primary or recurrent extremity sarcomas from 1994 to 2000 at our institution. RESULTS All patients had initial complete clinical responses to HILP, and the limb was salvaged in 4 of the 5 patients. Complications included chronic lymphedema, neuropathic pain, and prolonged wound healing. CONCLUSIONS HILP with melphalan is a safe and effective treatment option for selected patients with locally advanced and unresectable extremity sarcomas. The response rates are high, with limb salvage occurring in most patients. Further studies of larger groups of patients are warranted.
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Affiliation(s)
- C J Kim
- Cultaneous Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Fla. 33612-9497, USA
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Fuchs B, Davis AM, Wunder JS, Bell RS, Masri BA, Isler M, Turcotte R, Rock MG. Sciatic nerve resection in the thigh: a functional evaluation. Clin Orthop Relat Res 2001:34-41. [PMID: 11154002 DOI: 10.1097/00003086-200101000-00007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patients with a soft tissue malignancy involving the sciatic nerve who present with neurologic loss generally are advised to have an amputation. Twenty patients who underwent limb-sparing procedures with complete resection of the sciatic nerve as treatment for neurofibrosarcomas (12 patients), liposarcomas (four patients), malignant fibrous histiocytomas (two patients), recurrent desmoid tumor (one patient), and epithelioid hemangioendothelioma (one patient) were reviewed retrospectively. The mean age of these nine women and 11 men at the time of surgery was 51 years (range, 28-84 years). The right sciatic nerve was affected in 12 patients. These tumors were large and high grade. A mean of 22 cm of the nerve had to be resected (range, 8-42 cm). Ten patients received preoperative radiotherapy and 16 patients had intraoperative or postoperative radiotherapy. At a mean followup of 35 months (range, 7-97 months), 14 of the 20 patients were alive. Two patients had local recurrences develop (10%), whereas 12 patients had distant metastases. The function of the 10 patients as assessed by the Toronto Extremity Salvage Score averaged 74%. Most patients indicated that walking in the house is not difficult, but walking is compromised as soon as an effort is needed. Four patients walk without a cane, four needed one cane, and two needed two canes. The patients experienced stiffness, a sense of numbness, and premature fatigue. The use of analgesics was infrequent. Generally, patients rated themselves to be mildly to moderately disabled. From this small number of patients, it is shown that a tumor involving the sciatic nerve can be treated by limb-sparing surgery, including complete nerve resection, as an alternative to hip disarticulation or hindquarter amputation because the limb salvage option provides an acceptable functional outcome.
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Affiliation(s)
- B Fuchs
- Mayo Clinic, Department of Orthopedics, Rochester, MN 55905, USA
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Ham SJ, van der Graaf WT, Pras E, Molenaar WM, van den Berg E, Hoekstra HJ. Soft tissue sarcoma of the extremities. A multimodality diagnostic and therapeutic approach. Cancer Treat Rev 1998; 24:373-91. [PMID: 10189405 DOI: 10.1016/s0305-7372(98)90001-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S J Ham
- Department of Surgical Oncology, University Hospital Groningen, The Netherlands
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Ross DA, Lohman RF, Kroll SS, Yasko AW, Robb GL, Evans GR, Miller MJ. Soft tissue reconstruction following hemipelvectomy. Am J Surg 1998; 176:25-9. [PMID: 9683127 DOI: 10.1016/s0002-9610(98)00101-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Resection of primary and metastatic pelvic bone disease may result in large soft tissue deficits. Guidelines for soft tissue reconstruction following pelvic bone resection were evaluated in a retrospective study. METHODS Over a 5-year period 21 patients (31%) required soft tissue reconstruction following pelvic bone resection. Data on these patients were retrieved from case records. RESULTS Twelve patients underwent immediate, planned reconstruction, 1 a two-stage reconstruction, and 8 patients required a delayed procedure for complications after bone resection and primary closure. Soft tissue reconstruction was usually accomplished with muscle-based flaps; (25 flaps in 20 patients: 20 pedicled, 5 free), or with skin grafts alone (1 patient). Specific postreconstruction complications occurred in 9 patients, 5 in flaps based on the ipsilateral rectus muscle. CONCLUSION Flap closure is indicated to achieve primary closure and eliminate deadspace. The ipsilateral rectus muscle should be used with caution and contralateral-based rectus flaps considered. Indications for free flaps include the size and location of the defect and availability of tissue from an amputated limb.
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Affiliation(s)
- D A Ross
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
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Ham SJ, Schraffordt Koops H, Veth RP, van Horn JR, Eisma WH, Hoekstra HJ. External and internal hemipelvectomy for sarcomas of the pelvic girdle: consequences of limb-salvage treatment. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1997; 23:540-6. [PMID: 9484927 DOI: 10.1016/s0748-7983(97)93173-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The outcome of different limb-saving treatment modalities for pelvic girdle sarcoma is controversial. The oncological and functional results after 11 external and 10 internal hemipelvectomies and the consequences of limb-salvage treatment were studied in 21 consecutive patients with primary bone (19 patients) or soft tissue sarcoma (two patients) of the pelvic girdle. Following external hemipelvectomy, 10 patients (91%) died after a median follow-up of 1.6 years (range: 0.3-7.1). Isolated local recurrences occurred in three patients (27%), with concomitant distant failure in one (9%), while isolated distant failure occurred in six patients (55%). The rate of flap necrosis and wound infection following external hemipelvectomy were both 25%. Following internal hemipelvectomy, nine patients (90%) were alive without evidence of disease after a median follow-up of 6.6 years (range: 2.3-16.0). Concomitant local and distant failures were found in one patient (10%). Reconstruction-related complications necessitated revisional procedures in five of seven patients (72%), leading to external hemipelvectomy in one. Patients with a locally advanced pelvic girdle sarcoma who are unable to undergo an internal hemipelvectomy have a worse prognosis than patients who undergo an internal hemipelvectomy. An internal hemipelvectomy is not attended by an increased risk of local failure, but is by long-term local complications, requiring extensive surgical procedures.
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Affiliation(s)
- S J Ham
- Department of Surgical Oncology, Groningen University Hospital, The Netherlands
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