Management of Great Vessels and Nerves in Limb‐Salvage Surgery for Bone and Soft Tissue Tumors

Lun, Dengxing; Hu, Yongcheng; Huang, Hongchao

doi:10.1111/os.12066

Cited by 6 publications

(15 citation statements)

References 34 publications

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“…Autologous vein grafts, therefore, are preferred for young patients. Although the need for simultaneous venous reconstruction is controversial [18], we performed venous reconstruction with a GSV graft in this patient. No postoperative edema of the distal limb occurred, and the reconstructed vein remained patent through the final follow-up at 20 months.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous reconstruction of the bone and vessels for complex femoral defect

et al. 2016

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BackgroundSeveral methods have been reported for intercalary reconstruction of femoral defects. Of these, free vascularized fibula grafts (FVFG) are preferred because of their durability, bone-healing potential, and tolerance to infection. If the bone tumor invades the femoral vessels, simultaneous vascular reconstruction also becomes necessary and significant technical hurdles make limb salvage difficult.Case presentationWe present a 10-year-old girl who underwent limb-sparing surgery for a distal femur osteosarcoma. The femoral defect was 15 cm long, and the femoral vessel defect was 10 cm long. The femur was reconstructed with bilateral FVFG, and the femoral vessels were reconstructed with saphenous vein grafts. The grafts survived without vascular compromise, and the affected limb was preserved successfully.ConclusionsCombined use of bilateral FVFG and autologous vein grafts makes limb-sparing surgery for a large osteosarcoma of the femur possible.

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Section: Discussionmentioning

confidence: 99%

Simultaneous reconstruction of the bone and vessels for complex femoral defect

et al. 2016

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“…It appears that the inguinal region, the medial thigh compartment, and the popliteal fossa are common sites of lower limb STS with vascular involvement. 7 The reported frequency of major vascular involvement varies between 5% and 10% of all adult patients with STS of the lower extremity, with femoral vessels being reported as the most commonly involved vascular structures followed by the inguinal and popliteal vessels. [8][9][10] En bloc tumour resection, with resection of the great vessels, has been reported in up to 5.0% of all patients with lower extremity sarcomas.…”

Section: Authorsmentioning

confidence: 99%

“…[8][9][10] En bloc tumour resection, with resection of the great vessels, has been reported in up to 5.0% of all patients with lower extremity sarcomas. 7,[11][12][13] In contrast, nerve resection was carried out in only 1.2% of cases of lower limb STS with neural involvement, according to a study by Brooks et al 14 In a recent study, however, sciatic nerve involvement was reported at 15.0% of all lower limb STS, with 4.5% of all cases of lower extremity STS requiring complete nerve resection. 15 In this article, the authors aim to review the current literature regarding the multidisciplinary management of lower limb STS, with a focus on diagnostic and therapeutic management strategies of major neurovascular involvement.…”

Section: Authorsmentioning

confidence: 99%

“…8 Tumour-induced anatomical changes in surrounding vessels can be shown using digital subtraction angiography. 7 PET scanning is being increasingly employed as an imaging modality in the investigation of STS. In addition to screening for metastatic disease, particularly lymph node involvement, fluorodeoxyglucose PET scans may also be used as a prognostic tool in patients with STS due to the demonstrated correlation between tumour grade and fluorodeoxyglucose uptake.…”

Section: Selection Of Imaging Studiesmentioning

confidence: 99%

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Management of Lower Limb Soft Tissue Sarcomas with Major Neurovascular Involvement: Current and Future Perspectives

Tamimi

Sweiti

2021

EMJ Oncol

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Lower limb soft tissue sarcomas are a group of rare mesenchymal tumours that may grow in close anatomical proximity to major neurovascular structures, leading to significant oncological and surgical challenges for treating physicians. This article reviews the current literature on the multidisciplinary approach of treating lower limb soft tissue sarcomas with neurovascular involvement and describes the increasing shift towards limb-sparing surgeries, with an emphasis on improved functional outcomes based on a multimodal treatment approach. In addition to identifying the histological subtype of the tumour, classifying the neurovascular involvement precisely is key in planning the appropriate treatment. Existing classification systems for both vascular and neural involvement are discussed, and a combined neurovascular classification is proposed together with a general treatment algorithm.

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“…For STS with vascular involvement, reasonable oncological outcomes have been reported with vessel reconstruction in limb-salvage surgery [ 9 – 11 ]. Nerve reconstruction, on the other hand, does not guarantee preservation of function [ 12 ]. Tumor infiltration of the sciatic nerve has previously been an indication for limb amputation [ 13 ], but more recent studies have shown limb-sparing surgery with partial or complete sciatic nerve resection to be an excellent alternative [ 14 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Limb-Salvage Surgery of Soft Tissue Sarcoma with Sciatic Nerve Involvement

Sweiti

Tamimi

Bormann

et al. 2018

Sarcoma

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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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Management of Great Vessels and Nerves in Limb‐Salvage Surgery for Bone and Soft Tissue Tumors

Cited by 6 publications

References 34 publications

Simultaneous reconstruction of the bone and vessels for complex femoral defect

Simultaneous reconstruction of the bone and vessels for complex femoral defect

Management of Lower Limb Soft Tissue Sarcomas with Major Neurovascular Involvement: Current and Future Perspectives

Limb-Salvage Surgery of Soft Tissue Sarcoma with Sciatic Nerve Involvement

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