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Xu Y, Li Y, Fu Y, Wang B, Lin T, Zou C, Huang G, Shen J, Yin J. Autologous menisci-cruciate ligament composite as a flap for soft tissue reconstruction following malignant bone tumor resection around the knee. Cancer Med 2023; 12:8027-8037. [PMID: 36622149 PMCID: PMC10134327 DOI: 10.1002/cam4.5591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/01/2022] [Accepted: 12/17/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Despite significant improvements in oncological treatment, the management of soft tissue defects following malignant tumor resection remains challenging. We investigated whether autologous menisci and cruciate ligament, which are traditionally discarded, can be recycled as a supplemental flap in repairing soft tissue defects following malignant bone tumor resection and endoprosthetic reconstruction around the knee. METHODS Four knee specimens were dissected to provide a basis for the design of the menisci-cruciate ligament composite. Then, 40 patients with bone malignancies around the knee were enrolled and underwent reconstruction with free or vascularized composite following malignant tumor resection. The clinical, radiographic, and functional outcomes of this technique were evaluated in >1-year follow-up in each patient and compared with 87 patients who suffered from bone malignancies around the knee and were treated by limb salvage but without composite at our center over the same period. During the follow-up, a composite from one patient who underwent secondary amputation was retrieved and examined for in vivo remodeling. RESULTS Fourteen patients were treated with vascularized composite transfer (10 distal femurs and 4 proximal tibias) and 26 patients with free composite transfer (19 distal femurs and 7 proximal tibias). The composite can be used to cover the area of soft tissue defect from 22 to 48.38 cm2 (34.67 ± 6.48 cm2 ). With contrast-enhanced ultrasound, peripheral rim healing and dotted blood flow signal at the side of anastomosis were detected on a patient 16 months after free composite transfer. Gross macroscopic remodeling and histopathologic analysis of a retrieved composite also indicated good healing with surrounding tissues and living cells in the composite. The complications and oncologic outcomes were comparable between study and control cohorts, but better Musculoskeletal Tumor Society (MSTS) score for patients reconstructed with composite (26.68 vs. 25.66, p = 0.004). Of note, MSTS score was higher for patients reconstructed with composite at distal femur subdivision compared with the same subdivision in the control cohort (26.97 vs. 25.90, p = 0.009). No statically significant difference was noted in complications, oncologic, and functional outcomes for patients reconstructed with free or vascularized composite. CONCLUSION Autogenous menisci-cruciate ligament composite is an alternative option for soft tissue reconstruction. Either vascularized or free composite can be applied, depending on the size and localization of the defect.
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Affiliation(s)
- Yu Xu
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yan Li
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yiwei Fu
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Bo Wang
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tiao Lin
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Changye Zou
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Gang Huang
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jingnan Shen
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong, China
| | - Junqiang Yin
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, Guangdong, China
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Blay JY, Palmerini E, Bollard J, Aguiar S, Angel M, Araya B, Badilla R, Bernabeu D, Campos F, Chs CS, Carvajal Montoya A, Casavilca-Zambrano S, Castro-Oliden, Chacón M, Clara-Altamirano MA, Collini P, Correa Genoroso R, Costa FD, Cuellar M, Dei Tos AP, Dominguez Malagon HR, Donati DM, Dufresne A, Eriksson M, Farias-Loza M, Frezza AM, Frisoni T, Garcia-Ortega DY, Gerderblom H, Gouin F, Gómez-Mateo MC, Gronchi A, Haro J, Hindi N, Huanca L, Jimenez N, Karanian M, Kasper B, Lopes A, Lopes David BB, Lopez-Pousa A, Lutter G, Maki RG, Martinez-Said H, Martinez-Tlahuel JL, Mello CA, Morales Pérez JM, Moura DS, Nakagawa SA, Nascimento AG, Ortiz-Cruz EJ, Patel S, Pfluger Y, Provenzano S, Righi A, Rodriguez A, Santos TG, Scotlandi K, Mlg S, Soulé T, Stacchiotti S, Valverde CM, Waisberg F, Zamora Estrada E, Martin-Broto J. SELNET clinical practice guidelines for bone sarcoma. Crit Rev Oncol Hematol 2022; 174:103685. [PMID: 35460913 DOI: 10.1016/j.critrevonc.2022.103685] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
Bone sarcoma are infrequent diseases, representing < 0.2% of all adult neoplasms. A multidisciplinary management within reference centers for sarcoma, with discussion of the diagnostic and therapeutic strategies within an expert multidisciplinary tumour board, is essential for these patients, given its heterogeneity and low frequency. This approach leads to an improvement in patient's outcome, as demonstrated in several studies. The Sarcoma European Latin-American Network (SELNET), aims to improve clinical outcome in sarcoma care, with a special focus in Latin-American countries. These Clinical Practice Guidelines (CPG) have been developed and agreed by a multidisciplinary expert group (including medical and radiation oncologist, surgical oncologist, orthopaedic surgeons, radiologist, pathologist, molecular biologist and representatives of patients advocacy groups) of the SELNET consortium, and are conceived to provide the standard approach to diagnosis, treatment and follow-up of bone sarcoma patients in the Latin-American context.
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Affiliation(s)
- J Y Blay
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France.
| | - E Palmerini
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - J Bollard
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - S Aguiar
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - M Angel
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - B Araya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - R Badilla
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - D Bernabeu
- Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - F Campos
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - Caro-Sánchez Chs
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - A Carvajal Montoya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - S Casavilca-Zambrano
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - Castro-Oliden
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - M Chacón
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - M A Clara-Altamirano
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - P Collini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - R Correa Genoroso
- Hospital Clínico Universitario Virgen de la Victoria, Campus Universitario de Teatinos s/n, 29010, Malaga, Spain
| | - F D Costa
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - M Cuellar
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - A P Dei Tos
- Treviso General Hospital Treviso, University of Padua, Padova, Italy
| | - H R Dominguez Malagon
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - D M Donati
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - A Dufresne
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - M Eriksson
- Skane University Hospital and Lund University, Lund, Sweden
| | - M Farias-Loza
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - T Frisoni
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - D Y Garcia-Ortega
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - H Gerderblom
- Leiden University Medical Center, Leiden, The Netherlands
| | - F Gouin
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - M C Gómez-Mateo
- Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - J Haro
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - N Hindi
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
| | - L Huanca
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima, Peru
| | - N Jimenez
- Hospital San Vicente de Paúl, Avenue 16, streets 10 and 14, Heredia, Costa Rica
| | - M Karanian
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - B Kasper
- University of Heidelberg, Mannheim Cancer Center, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - A Lopes
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - B B Lopes David
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Lopez-Pousa
- Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - G Lutter
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - R G Maki
- University of Pennsylvania, Abramson Cancer Center, 3400 Civic Center Boulevard, Philadelphia, PA 19104 USA
| | - H Martinez-Said
- Centro Oncologico Integral, Hospital Medica Sur, Planta Baja Torre III - Cons. 305, Col. Toriello Guerra, Deleg. Tlalpan. C.P., 14050, Mexico, D.F
| | - J L Martinez-Tlahuel
- Instituto Nacional de Cancerologia, Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP, 14080 Tlalpan Mexico
| | - C A Mello
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - J M Morales Pérez
- Centro Oncologico Integral, Hospital Medica Sur, Planta Baja Torre III - Cons. 305, Col. Toriello Guerra, Deleg. Tlalpan. C.P., 14050, Mexico, D.F
| | - D S Moura
- Hospital Universitario Virgen del Rocio, Av Manuel Siurot s/n, 41013 Sevilla, Spain
| | - S A Nakagawa
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - A G Nascimento
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - E J Ortiz-Cruz
- Hospital Universitario La Paz, MD Anderson Cancer Center, Calle de Arturo Soria, 270, 28033 Madrid, Spain
| | - S Patel
- UT MD Anderson Cancer Center, Houston, TX, USA
| | - Y Pfluger
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - S Provenzano
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Righi
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - A Rodriguez
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - T G Santos
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - K Scotlandi
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136, Bologna, Italy
| | - Silva Mlg
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo 01509-010, Brazil
| | - T Soulé
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - S Stacchiotti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - C M Valverde
- Vall d´Hebrón University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - F Waisberg
- Instituto Alexander Fleming, Av. Cramer 1180. CP, C1426ANZ Buenos Aires, Argentina
| | - E Zamora Estrada
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - J Martin-Broto
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
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