Reconstructive Treatment following Resection of High-Grade Soft-Tissue Sarcomas of the Lower Limb

Leow, A M; Halim, Ahmad Sukari; Zulmi, W

doi:10.1177/230949900501300110

Cited by 10 publications

(19 citation statements)

References 17 publications

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“…These include latissimus dorsi, rectus abdominis, and scapula flaps [6] . When there is a large contour defect in the popliteal fossa that does not require much filling of the muscular space, Leow et al [10] have also described the use of a free minitransverse rectus abdominis (TRAM) myocutaneous flap.…”

Section: Kneementioning

confidence: 99%

“…The use of a free rectus abdominis flap has been reported to be particularly successful for this purpose [6,10] . The latissimus dorsi flap, which is thin, large with a long vascular pedicle, ± neurotization has also been used for large defects of the thigh [6,10] . The use of the anterior lateral thigh (ALT) flap for large thigh defects, particularly of the posterior thigh, has also been reported [15] .…”

Section: Radial Forearm Ld Gracilismentioning

confidence: 99%

“…Additionally for radiationinduced long-bone fractures, the vascularized fibula can also be osteotomized longitudinally and used as an onlay graft [37] . The fibula can also be harvested as a combined osteocutaneous flap for composite defects of the lower extremity [6,10] . An additional osteomuscular flap that has been reported to have good outcomes for coverage after distal tibial osteosarcoma resection is the fibula-flexor hallucis longus osteomuscular flap [38] .…”

Section: Bone Involvementmentioning

confidence: 99%

“…Aesthetically, reconstruction of the thigh requires a large flap with muscle bulk that can eliminate dead space while providing adequate contour [10] . The use of a free rectus abdominis flap has been reported to be particularly successful for this purpose [6,10] .…”

Section: Radial Forearm Ld Gracilismentioning

confidence: 99%

“…To this end both pedicled and free tissue transfers have become a central component of lower extremity salvage after resection and chemo-radiation therapy. Recent data has shown that these complex reconstructions have provided faster recovery with adequate soft tissue reconstruction and maintenance of functionality of the limb [2,[6][7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

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Complex reconstruction of the lower extremity following sarcoma resection: a literature review

Azadgoli¹,

Carre²,

Perrault³

et al. 2018

PAR

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While amputation was traditionally the only option available for patients with sarcomas of the extremities, chemotherapy, radiation, and advances in microsurgical technique have allowed many patients to undergo limb-salvaging procedures. Given the low incidence and heterogeneity of these tumors, there is currently no standard treatment algorithm for limb reconstruction after large sarcoma resection. Thus, we systematically reviewed the various types of free tissue transfer used for the reconstruction of lower limbs after sarcoma resection. Techniques were described based on anatomic location. This literature review supports free tissue transfer as a safe and acceptable modality for reconstruction after sarcoma resection of the lower limb. It allows for the application of healthy vascularized tissue to the defect while also providing freedom of flap positioning. Flap choice is dependent on tumor and defect size, tissue type and function, as well as donor site availability.

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Section: Kneementioning

confidence: 99%

Section: Radial Forearm Ld Gracilismentioning

confidence: 99%

Section: Bone Involvementmentioning

confidence: 99%

Section: Radial Forearm Ld Gracilismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Complex reconstruction of the lower extremity following sarcoma resection: a literature review

Azadgoli¹,

Carre²,

Perrault³

et al. 2018

PAR

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Continuous local intraarterial infusion of anticoagulants for microvascular free tissue transfer in primary reconstruction of the lower limb following resection of sarcoma

et al. 2010

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In free tissue transfers, preventing microvascular thrombosis is the first priority to achieve a successful result. Numerous protocols exist for preventing thrombosis postoperatively. We performed continuous local intraarterial infusion of anticoagulants in 11 patients undergoing wide resection of malignant soft tissue tumors, followed by primary microvascular reconstruction in the lower limb. A catheter designed for epidural anesthesia was inserted into the femoral artery and connected to a syringe pump. A daily dose of 100 ml comprising 2,000 U of heparin and 40 microg of prostaglandin E(1) was administered by means of continuous infusion for seven consecutive days as a standard regime. There were no cases of thrombosis during the continuous local intraarterial infusion of anticoagulants. There were no serious systemic complications. Although we have described limited cases and supporting data are lacking, we feel that this procedure might be useful for microsurgical reconstruction of the lower limb.

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Complications of limb salvage surgery in childhood tumors and recommended solutions

Özger¹,

Bulbul²,

Eralp³

2009

Strategies in Trauma and Limb Reconstruction

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Bone and soft tissue malignancies are associated with serious diagnostic and therapeutic problems in every level of pubertal growth in children. Current treatment modality preferred in bone and soft tissue tumors is wide resection of tumor followed by the reconstruction of consequent defect by various methods. Chemotherapy and radiotherapy are applied for systemic effects to the patient pre- and post-operatively and for local effects that facilitate the surgical procedure. Mostly, it is very difficult to control problems following wide resection and reconstruction. In this study, our aim is to discuss the problems encountered in different resection and reconstruction approaches in childhood bone and soft tissue tumors, and the recommended solutions addressed to these problems. From 1990 to 2003, a total of 68 patients (38 female, 30 male) with a mean age of 13.1 (1.5–18) were included in the study. 85.3% of patients were diagnosed as osteosarcoma and the rest was Ewing’s sarcoma. Seventy-five percent of patients had stage IIB disease. The lesions of 34 patients were detected to be in distal femur, 26 in proximal tibia and fibula, 4 in foot and ankle joint, and the remaining 4 in pelvis. As reconstructive surgery, 40 patients had modular prosthesis, vascularized fibular graft was performed in 13 patients, and 10 patients underwent arthrodesis with vascularized fibular graft. 20.6% of patients had shortened limb, infection was detected in 4 patients, laxity in 5, and restricted motion in 4 as complication of prosthesis. With sacrificed physis, 13 patients had a mean value of 4.6 cm limb shortness. Limb salvage surgery has been considered as the gold standard treatment in orthopedic oncological surgery. More understanding of the biology of sarcoma, introduction of new effective chemotherapeutic agents, development of new techniques concerning the surgical resection, advances in diagnostic methods, and improvements in reconstructive surgery all make a major contribution to limb salvage surgery. Since some problems are still encountered, we offer a therapeutic algorithm for complications in the management of childhood tumors that we have encountered so far.

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Reconstructive Treatment following Resection of High-Grade Soft-Tissue Sarcomas of the Lower Limb

Abstract: Tissue transfer allows early adjuvant therapy facilitating the multimodal approach for the high-grade soft-tissue sarcomas of the lower extremity.

Cited by 10 publications

References 17 publications

Complex reconstruction of the lower extremity following sarcoma resection: a literature review

Complex reconstruction of the lower extremity following sarcoma resection: a literature review

Continuous local intraarterial infusion of anticoagulants for microvascular free tissue transfer in primary reconstruction of the lower limb following resection of sarcoma

Complications of limb salvage surgery in childhood tumors and recommended solutions

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