Vascular reconstruction in lower limb musculoskeletal tumours

Amputation risk after the revascularization procedures in sarcoma resections

Objective

The objective of this study is to evaluate the efficacy of vascular reconstructive surgery after resection of bone and soft tissue tumors in extremities and the risk of progression to amputation.

Methods

This is a retrospective, observational data collection from medical records of patients who underwent resection of bone and soft tissue tumors in the period of 2002–2015. Thirteen patients met the inclusion criteria, which evaluated the correlations between certain factors (gender, tumor type, location, reconstruction, revascularization and patency, infection) with amputation in the postoperative period.

Results

In this study, of the 13 patients undergoing reconstruction, five (38.46%) evolved to amputation. All patients who progressed to amputation had the following in common: presence of bone sarcoma (p = 0.005), having undergone reconstruction with an orthopedic prosthesis (p = 0.005), lack of vascular patency in the revascularization site in the postoperative period (p = 0.032), and surgical site infection (p = 0.001). None of the patients with soft tissue sarcoma underwent amputation, and the only patient with bone sarcoma who did not undergo amputation had no infection and maintained vascular patency of the graft.

Conclusion

The occurrence of infection appears to be one of the main risk factors for failure of revascularization, especially in cases of bone sarcoma in which vascular reconstruction is performed with placement of a non-conventional joint prosthesis.

Primary flap reconstruction of tissue defects after sarcoma surgery enables curative treatment with acceptable functional results: a 7-year review

Background

Sarcomas, a heterogeneous group of tumors, are challenging to treat and require multidisciplinary cooperation and planning. We analyzed the efficacy of flap reconstruction in patients with bone and soft tissue sarcoma.

Methods

Patient charts and operative records were retrospectively reviewed from January 2006 through October 2013 to identify sarcoma patient characteristics, postoperative complications, revisions, recurrences, and survival. Pedicled and/or free flap reconstruction was performed in 109 patients. Flap selection was based on defect size, and exposure of anatomically critical structures or major orthopedic implants.

Results

Of 109 patients, 71 (65.1 %) were men, and mean age was 56.4 years. Tumors most frequently located in a lower extremity (38.7 %). Primary sarcomas comprised 79.2 % and recurrences occurred in 18.9 %. Wide resection was performed for 65.7 %, and there were 10 planned amputations combined with flap reconstruction. A total of 111 tumors received 128 flaps: 76 pedicled flaps, 42 free flaps, and 5 combined (10 total) pedicled + free-flaps. The success rate was 94 % for the pedicled flap group, 97 % for the free-flap group, and 100 % for the pedicle + free-flap group. Of 35 patients, 5 developed deep prosthetic infections. Only one amputation due to disease progression was performed. Satisfactory functional outcome was achieved in 69 %. Survival rate during a mean (standard deviation) 3(2) year follow-up was 83.5 %.

Conclusions

Primary flap reconstruction after sarcoma surgery satisfies oncologic goals. Large tumors in difficult areas can be removed and complete tumor resection achieved. Our findings indicate a high survival rate after sarcoma surgery utilizing flap reconstruction and a low recurrence rate.

Management of great vessels and nerves in limb-salvage surgery for bone and soft tissue tumors

In recent years, limb-salvage surgery has gradually replaced amputations and become one of the main treatment strategies for patients with bone and soft tissue tumors of the extremities. The goals of tumor resection in limb-salvage surgery are to reduce the recurrence rate and preserve as much limb function as possible. However, depending on the size and specific location of the tumor, large neurovascular bundles may be involved. In addition, management of large nerves and vessels can make wide marginal resection more difficult. Sites where these problems commonly arise include the sciatic and tibial common peroneal nerve, artery and vein in the lower limbs.

Curative resection and reconstruction of the inferior vena cava after extensive infiltration with low-grade endometrial stromal sarcoma

Endometrial stromal sarcoma (ESS) rarely infiltrates the great vessels. We report a successful surgical resection of the inferior vena cava (IVC) after extensive infiltration with metastatic low-grade ESS. A case of presumed recurrence of low-grade ESS demonstrated complete IVC occlusion from tumour thrombus with extensive local disease. Radical resection of the tumour and caval reconstruction was performed. The IVC graft was thrombosed at short-term follow-up. Curative resection of extensive caval infiltration with metastatic low-grade ESS can be achieved. Caval reconstructive procedures may be redundant in the presence of an adequate collateral circulation.