The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas

Abstract

Background: Soft tissue sarcoma (STS) treatment is an interdisciplinary challenge. Along with radio(chemo)therapy, surgery plays the central role in STS treatment. Little is known about the impact of reconstructive surgery on STS, particularly whether reconstructive surgery enhances STS resection success with the usage of flaps. Here, we analyzed the 10-year experience at a university hospital’s Comprehensive Cancer Center, focusing on the role of reconstructive surgery. Methods: We performed a retrospective analysis of STS-patients over 10 years. We investigated patient demographics, diagnosis, surgical management, tissue/function reconstruction, complication rates, resection status, local recurrence and survival. Results: Analysis of 290 patients showed an association between clear surgical margin (R0) resections and higher-grade sarcoma in patients with free flaps. Major complications were lower with primary wound closure than with flaps. Comparison of reconstruction techniques showed no significant differences in complication rates. Wound healing was impaired in STS recurrence. The local recurrence risk was over two times higher with primary wound closure than with flaps. Conclusion: Defect reconstructions in STS are reliable and safe. Plastic surgeons should have a permanent place in interdisciplinary surgical STS treatment, with the full armamentarium of reconstruction methods.

IGF-I and Hyaluronic Acid Mitigate the Negative Effect of Irradiation on Human Skin Keratinocytes

“…In this study, we were able to demonstrate the well-known decrease in cell viability after irradiation. These findings are in concordance with the study of Tureson et al [5,9,26]. With daily 1.1 Gy dose fractions, a continued and increasing cell depletion was observed in the skin.…”

“…Radiation resembles the standard treatment protocol for certain cancer types, such as head and neck, breast, and lung cancers [2]. Even though it represents a crucial part of the treatment protocol for malignant diseases, it can have many adverse effects, ranging from acute toxicity, such as acute radiation syndrome, to chronic sequelae related to stimulation of the inflammatory and necrotic processes that may necessitate secondary measures [1,[3][4][5][6]. Radiation can damage human tissue-either by direct or indirect pathways-leading to a disruption of the physiological healing process which normally comprises hemostasis, inflammation, proliferation, and skin remodeling [7].…”

The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany—Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa)

“…In this context, our findings of independently increased limb-salvage rates in patients with defect reconstruction according to plastic surgery principles generally fit in well with the previously published reports [ 30 , 32 ]. In addition, recent works by Slump, Götzl, and Dadras et al have repeatedly demonstrated that flap-based reconstructive approaches do not increase local recurrence or overall mortality rates, which is well in line with our findings [ 46 , 47 , 48 ]. Yet, by evaluating the admission details of STS patients to their department in Spain between 2000 and 2010, Marré et al found that about half of all cases were late referrals with higher subsequent complication rates, leading them to both emphasize the importance of early plastic surgery participation as well as lament the lack of clear-cut referral guidelines [ 42 ].…”

Intraoperative angiography imaging correlates with wound complications following soft tissue sarcoma resection

“…Additionally, while our goal in this study was to characterize the capacity to predict wound complications, we do not know for certain if there are interventions that can be performed at that time of surgery that would actually change the likelihood of a wound complication. Still, the fact remains that when confronted with a wound that is unlikely to heal, the surgeon could choose not to close the wound in favor of another option (such as flap placement by a plastic surgeon or delayed closure) 17,21,22,41 . Another limitation lies in the retrospective correlation of tissue signal with wound complications.…”

“…Still, the fact remains that when confronted with a wound that is unlikely to heal, the surgeon could choose not to close the wound in favor of another option (such as flap placement by a plastic surgeon or delayed closure). 17,21,22,41 Another limitation lies in the retrospective correlation of tissue signal with wound complications. It is possible that this method of tissue signal analysis introduces a source of bias that would not hold true in a truly prospective study design.…”