F Simunovic1, U Wittel2, B Passlick3, S Wiesemann3, M Czerny4, M Südkamp4, G B Stark1, H Bannasch1. 1. Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg. 2. Klinik für Allgemein und Viszeralchirurgie, Universitätsklinikum Freiburg. 3. Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg. 4. Klinik für Herz und Gefäßchirurgie, Universitätsklinikum Freiburg.
Abstract
BACKGROUND: The resection of large soft-tissue sarcoma requires reconstruction with free flaps. The choice of recipient vessels is crucial for the success of surgery. PATIENTS: We report four cases with large soft-tissue sarcomas with complex anatomical relationships: two tumors of the thigh surrounding the femoral neurovascular structures and two tumors of the abdomen with infiltration of the thorax and the abdomen. All cases received multimodal interdisciplinary treatment. The anterolateral thigh (ALT) flap and the latissimus dorsi (LD) flap were employed twice for defect coverage in this series. In all cases the deep inferior epigastric (DIE) vessels were transposed to the subcutaneous compartment and used as recipient vessels. RESULTS: The mean duration of surgery was 694 ± 149 minutes. The mean weight of the tumor specimen was 3069 ± 1267 g. Three flaps healed primarily and one exhibited a minor necrosis, which was treated by excision and secondary suture. There were no cases of abdominal herniation due to the transposition of vessels. CONCLUSION: Transposition of DIE-vessels to the subcutaneus compartment is a good alternative for free flap revascularisation in this patient group. In this position, the vessels are easily accessed and used for microsurgery. This technical modification increases the reconstructive possibilities in large and previously irradiated surgical defects. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: The resection of large soft-tissue sarcoma requires reconstruction with free flaps. The choice of recipient vessels is crucial for the success of surgery. PATIENTS: We report four cases with large soft-tissue sarcomas with complex anatomical relationships: two tumors of the thigh surrounding the femoral neurovascular structures and two tumors of the abdomen with infiltration of the thorax and the abdomen. All cases received multimodal interdisciplinary treatment. The anterolateral thigh (ALT) flap and the latissimus dorsi (LD) flap were employed twice for defect coverage in this series. In all cases the deep inferior epigastric (DIE) vessels were transposed to the subcutaneous compartment and used as recipient vessels. RESULTS: The mean duration of surgery was 694 ± 149 minutes. The mean weight of the tumor specimen was 3069 ± 1267 g. Three flaps healed primarily and one exhibited a minor necrosis, which was treated by excision and secondary suture. There were no cases of abdominal herniation due to the transposition of vessels. CONCLUSION: Transposition of DIE-vessels to the subcutaneus compartment is a good alternative for free flap revascularisation in this patient group. In this position, the vessels are easily accessed and used for microsurgery. This technical modification increases the reconstructive possibilities in large and previously irradiated surgical defects. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Daniel Kraus; Felix Oettinger; Jurij Kiefer; Holger Bannasch; G Björn Stark; Filip Simunovic Journal: J Oncol Date: 2021-04-27 Impact factor: 4.375