Soft Tissue Coverage of the Lower Limb following Oncological Surgery

Radtke, Christine; Panzica, Martin; Dastagir, Khaled; Krettek, Christian; Vogt, Peter M.

doi:10.3389/fonc.2015.00303

Cited by 12 publications

(18 citation statements)

References 27 publications

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“…In traumatic cases, longer vascular pedicles are often required to place the microvascular anastomoses outside of the zone of injury [1]. Reconstruction with well-vascularized free tissue transfer for lower extremity reconstruction after oncological resection proved safe and effective in patients undergoing postoperative radiation therapy [6,23]. Free flap reconstruction has led to advances in limb-sparing resection of tumors of the lower extremities [24].…”

Section: Discussionmentioning

confidence: 99%

“…Local flaps provide similar tissue characteristics, thickness, and weight-bearing capacity to the reconstructed areas [3]. Microsurgical free flap reconstruction is widely established in traumatic and non-traumatic lower extremity defects and was proven to be safe in patients of advanced age, although the patients suitability to undergo extended surgeries needs to be explored [4][5][6]. The timing of reconstructive surgery is influenced by multiple factors including the patients' general state and the contamination of the wound; however, in traumatic defects, early free tissue transfer was associated with less complications than delayed reconstruction [7].…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction of traumatic and non-traumatic lower extremity defects with local or free flaps

et al. 2021

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Summary Background Despite continuous surgical advances, reconstruction of complex lower extremity wounds remains challenging. The indication of local flaps or microsurgical free tissue transfer depends on the anatomical location and size of the defect, as well as the comorbidities and general condition of the patient. In this study, local and free flap reconstruction of distal lower extremity defects was assessed, and postoperative complications and limb salvage were analyzed. Methods A total of 34 patients were included in this retrospective study. Distal lower extremity defects were of traumatic (29%) and non-traumatic (71%) etiologies. Patient characteristics, flap selection, postoperative complications, and limb preservation within the first 12 months were assessed and compared by reconstructive treatment concept. Statistical analysis included parametric and non-parametric tests. The two-sided alpha was set at 5% for all statistical tests. Results While 21 patients were treated with local flaps, 13 patients underwent microsurgical free flap reconstruction. The most common comorbidities were peripheral vascular disease and diabetes. Local flaps included the gastrocnemius muscle flap, soleus flap, sural flap, and plantaris medialis flap. The most commonly used free flaps for soft tissue reconstruction were latissimus dorsi and gracilis muscle flaps. The overall lower extremity preservation rate was 94.1%. There was one case of below-knee amputation 1 month after free flap reconstruction, and one case of first-ray amputation of the foot after local flap coverage. Conclusion Reconstruction of lower extremity defects can be achieved by local or free flap reconstruction. Flap selection is influenced by anatomical location, defect size, and patient factors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reconstruction of traumatic and non-traumatic lower extremity defects with local or free flaps

et al. 2021

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“…The literature does not report a significant difference between reconstruction and amputation in primary cases [9]. Surgical treatment has moved in the direction of reconstructive interventions [3]. However, it has been suggested that in cases of recurrence or pathological fractures, or when the tumor cannot be removed surgically, amputation is more effective in the local control of the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Because of technological advances and increasing experience in oncological treatment, there have been significant developments in the treatment of these patients and survival rates have become higher [2]. When the literature is reviewed, it can be seen that surgical treatment by amputation has become less prevalent than limb salvage surgery since the 1990s as a result of good results reported following reconstruction [3]. The purpose of limb salvage surgery is to maintain the functions of the extremity and to remove the local disease completely.…”

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Analysis of 24 Patients Who Were Amputated Due to a Malignant Tumor in the Skeleton

Göçer¹

2016

Ann Clin Anal Med

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ÖzetAmaç: Kliniğimizde primer malign ve metastatik kemik ve yumuşak doku tü-mörü nedeniyle amputasyon uygulanan olguların değerlendirilmesi amaçlan-dı. Gereç ve Yöntem: Ocak 1987-Ocak 2012 yılları arasında, ekstremite primer malign ve metastatik kemik ve yumuşak doku tümörü nedeniyle amputasyon uygulanan 24 olgu retrospektif olarak incelendi. Olgular yaş, cinsiyet, patolojik tanı, lokalizasyon, amputasyon tipi, sağkalım ve özellikleri açısın-dan değerlendirildi. Elde edilen veriler SPSS 15.0 sistemine aktarılarak analiz edildi. Verilerin normal dağılıma uyup uymadığı Shapiro-Wilk testi ile değer-lendirildi. Bulgular: 24 olgunun 17'si (%70) erkek, 7'si (%30) kadın ve yaş ortalaması 42 (12-68) yıl idi. En sık cilt kanseri (%25), Ewing sarkomu (%20.8), Osteosarkom (%16.6) ve diğerleri (Malign mezenkimal tümör, kodrosarkom, sinovial sarkom, metastatik tümör) nedeniyle amputasyon yapıldığı görüldü. 24 hastanın 16'sı en az bir defa farklı merkezde daha önce müdahale edildiği görüldü. En sık diz üstü amputasyon (%58.3), diz altı amputasyon (%25), ve diğerleri (kalça dezartikülasyonu, dirsek altı amputasyon) uygulandı. 8 hastada cilt problemleri görüldü ve 6'sına debridman yapıldı. Postoperatif ilk bir yıl içinde 14 olgunun kaybedildiği gözlendi. Tartışma: Hastanın diğer sağlık sorunlarının tedavisi ve ileri evre malign ekstremite tümörlerinin hızlı ve lokal kontrolü için amputasyon yapılabilir. Anahtar KelimelerMalign Tümör; Primer; Metastatik; Cerrahi; Amputasyon Abstract Aim: The purpose of the study was to assess the cases that were amputated in our clinic due to primary malignant and metastatic bone and soft tissue tumor. Material and Method: 24 cases that were amputated due to primary malignant and metastatic bone and soft tissue tumor between January 1987 and January 2012 were examined retrospectively. The cases were assessed in terms of age, gender, pathological diagnosis, localization, type of amputation, survival and characteristics. The data obtained were transferred to SPSS 15.0 program and analyzed. Normality distributions of the data were analyzed with Shapiro-Wilk test. Results: Of the 24 cases, 17 (70%) were men, while 7 (30%) were women and the average age was 42 (between 12 and 68). The most common reasons for amputation were skin cancer (25%), Ewing sarcoma (20.8%), Osteosarcoma (16.6%) and others (Malignant mesenchymal tumor, chondrosarcoma, synovial sarcoma, metastatic tumor). 16 of these patients had previously received an intervention in a different centre at least once. The most common type of amputation was above-knee amputation (58.3%), below-knee amputation (25%) and others (hip disarticulation, below-elbow amputation). 8 patients were found to have skin problems and debridement was performed on 6. 14 cases died within the postoperative first year. Discussion: Amputation can be performed for the treatment of the patient's other health problems and fast and local controls of advanced malignant extremity tumors.

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“…The optimum approach to the prevention of wound problems is the careful preoperative planning of soft tissue reconstruction, sand their performance in the same session as the resection . One of the most commonly used methods to be applied when wound problems occur is Negative Pressure Wound Therapy (NPWT), which creates a pressure gradient between the wound and the suction through a direct effect.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting postmusculoskeletal tumour surgery wound problem treatment with negative pressure wound therapy

Baysal

Sağlam

Akgülle

et al. 2020

International Wound Journal

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The aim of the study is to investigate the risk factors identified in literature that have been associated with prolonged Negative Pressure Wound Therapy (NPWT). Our study included patients who developed local wound problems after bone or soft tissue sarcoma surgery with negative margin at our clinic between 2012 and 2018 and treated with NPWT. All patients were followed up of at least 6 months. Sex, albumin level, skin infiltration, type of wound problem, postoperative intensive care unit (ICU) requirement, and intraoperative blood loss were found to be influential factors on NPWT > 10 sessions. We conclude that treatment may be prolonged and the necessary precautions need to be taken in patients with an impaired preoperative nutritional condition, with intraoperative high amount of blood loss, and with long postoperative stays in the ICU as well as if the underlying cause for wound problem is an infection.

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Soft Tissue Coverage of the Lower Limb following Oncological Surgery

Cited by 12 publications

References 27 publications

Reconstruction of traumatic and non-traumatic lower extremity defects with local or free flaps

Reconstruction of traumatic and non-traumatic lower extremity defects with local or free flaps

Analysis of 24 Patients Who Were Amputated Due to a Malignant Tumor in the Skeleton

Factors affecting postmusculoskeletal tumour surgery wound problem treatment with negative pressure wound therapy

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