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

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.

Functional Muscle Transfer after Oncologic Extremity Resection

“…The included articles were published from 1993 to 2021 and were categorized as level 4 or 5 according to OCEBM. 4 5 6 7 8 9 10 11 12 13 14 15 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43…”

“…The included articles were published from 1993 to 2021 and were categorized as level 4 or 5 according to the Oxford Centre for Evidence-Based Medicine (OCEBM). [4][5][6][7][8][9][10][11][12][13][14][15][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]…”

“…FMT can be harvested with the muscle's neurovascular pedicle for a distant transfer or islandized on its neurovascular pedicle and rotated. The latissimus dorsi (LD), [4][5][6][7] gracilis, [8][9][10] tensor fasciae lata (TFL), 5,7,8,11 and vastus lateralis [12][13][14][15] are the most commonly used donor muscles for FMT. Aside from restoring motor function to the involved extremity, FMT with vascularized, nonirradiated tissue provides…”

“…FMT can be harvested with the muscle's neurovascular pedicle for a distant transfer or islandized on its neurovascular pedicle and rotated. The latissimus dorsi (LD), [4][5][6][7] gracilis, [8][9][10] tensor fasciae latae (TFL), 5,7,8,11 and vastus lateralis [12][13][14][15] are the most commonly used donor muscles for FMT. Aside from restoring motor function to the involved extremity, FMT with vascularized, nonirradiated tissue provides several other reconstructive advantages over local options, all of which potentiate more reliable wound healing: improved soft tissue resurfacing, ample tissue volume for filling dead space, and durable coverage or critical neurovascular structures and/or bone.…”