Homoinjerto de aparato extensor y radioterapia en el tratamiento de sarcomas de partes blandas del entorno de la rodilla. A propósito de 2 casos clínicos / Extensor mechanism allograft and radiotherapy in the treatment of soft tissue sarcomas around the knee: Presentation of two clinical cases

Objetivo. La afectación de la rodilla por sarcomas de partes blandas es rara y muy difícil de tratar. La reconstrucción del aparato extensor de la rodilla es fundamental para restaurar la funcionalidad. El resultado funcional está comprometido por la cobertura deficiente de tejidos blandos, la radioterapia local adyuvante y la resección del aparato extensor. No hemos encontrado literatura escrita del resultado del tratamiento mediante resección y reconstrucción del aparato extensor en combinación con radioterapia adyuvante, ni se conocen los efectos de la radioterapia en los homoinjertos. Material y método. Presentamos 2 casos clínicos de sarcoma de partes blandas del entorno de la rodilla tratados mediante resección, reconstrucción del aparato extensor mediante homoinjerto de cadáver criopreservado y posterior radioterapia local. Resultados. Tras más de 3 años de seguimiento ambos pacientes están libres de enfermedad y presentan buen balance articular. Discusión y conclusiones. La resección del tumor con adecuados márgenes de seguridad y la reconstrucción mediante homoinjerto de cadáver permite preservar el mecanismo extensor y la funcionalidad. La cobertura de tejidos blandos es un problema añadido que puede solventarse mediante la cobertura con colgajo fasciocutáneo Propeller. Después de la cirugía la rodilla se ha de inmovilizar con una ortesis bloqueada en extensión. La radioterapia local contribuye al control local de la enfermedad. La reconstrucción del aparato extensor de la rodilla con homoinjerto es una alternativa funcional a la amputación, y no contraindica la radioterapia adyuvante para mejorar el control local de la enfermedad (AU)

Objective. Knee involvement of soft tissue sarcomas is rare and very difficult to treat. Reconstruction of the extensor mechanism of the knee is essential to restore the functionality. Functional outcome is compromised by poor soft tissue coverage, adjuvant local radiotherapy, and resection of the extensor apparatus. No results were found in the literature as regards treatment by resection and reconstruction of the extensor mechanism in combination with adjuvant radiotherapy. The effects of radiotherapy are also unknown in the allografts. Material and method. . Two cases are presented of soft tissue sarcoma around de knee treated by resection, reconstruction of the extensor mechanism with cryopreserved cadaver allograft, and local radiotherapy. Results. After more than 3 years of follow up, both patients are free of disease and have a good joint balance. Discussion and conclusions. Resection of the tumor with adequate safety margins and reconstruction using cadaveric allograft preserves the extensor mechanism and function of the limb. The soft tissue coverage is an added problem that can be solved by propeller fasciocutaneous flap coverage. After surgery, the limb must be immobilized with a knee brace locked in extension. Local radiotherapy contributes to local control of the disease. The reconstruction of the extensor mechanism of the knee with allograft is a functional alternative to amputation, and it does not contraindicate adjuvant radiotherapy to improve local control of the disease (AU)

[Extensor mechanism allograft and radiotherapy in the treatment of soft tissue sarcomas around the knee: Presentation of two clinical cases]. / Homoinjerto de aparato extensor y radioterapia en el tratamiento de sarcomas de partes blandas del entorno de la rodilla. A propósito de 2 casos clínicos.

OBJECTIVE: Knee involvement of soft tissue sarcomas is rare and very difficult to treat. Reconstruction of the extensor mechanism of the knee is essential to restore the functionality. Functional outcome is compromised by poor soft tissue coverage, adjuvant local radiotherapy, and resection of the extensor apparatus. No results were found in the literature as regards treatment by resection and reconstruction of the extensor mechanism in combination with adjuvant radiotherapy. The effects of radiotherapy are also unknown in the allografts. MATERIAL AND METHOD: . Two cases are presented of soft tissue sarcoma around de knee treated by resection, reconstruction of the extensor mechanism with cryopreserved cadaver allograft, and local radiotherapy. RESULTS: After more than 3 years of follow up, both patients are free of disease and have a good joint balance. DISCUSSION AND CONCLUSIONS: Resection of the tumor with adequate safety margins and reconstruction using cadaveric allograft preserves the extensor mechanism and function of the limb. The soft tissue coverage is an added problem that can be solved by propeller fasciocutaneous flap coverage. After surgery, the limb must be immobilized with a knee brace locked in extension. Local radiotherapy contributes to local control of the disease. The reconstruction of the extensor mechanism of the knee with allograft is a functional alternative to amputation, and it does not contraindicate adjuvant radiotherapy to improve local control of the disease.