La tomografía por emisión de positrones asociada con la tomografía computarizada en tumores del aparato locomotor / Positron emission tomography-computed tomography in tumors of the locomotor apparatus

La tomografía por emisión de positrones asociada con la tomografía computarizada (PET/TC) es una técnica de imagen híbrida que combina la información anatómica de la TC con la metabólica tras la administración de radiofármacos específicos, de los cuales el más usado es la 18F-fluordesoxiglucosa (FDG). La mayor captación de FDG de las lesiones malignas es la base para la aplicación de la técnica en oncología. En el aparato locomotor hay captaciones óseas y en partes blandas que son fisiológicas o benignas y que se deben diferenciar de las malignas, secundarias o primarias. Las limitaciones más importantes son los procesos inflamatorios o infecciosos activos (positivos en PET) y las lesiones de tamaño inferior a un centímetro, quísticas, necróticas o de bajo grado (negativos en PET). La PET/TC en el aparato locomotor permite especialmente la detección de metástasis de los tumores más frecuentes. También se utiliza en la estadificación y monitorización de la respuesta al tratamiento de algunos tumores hematológicos como el linfoma (donde la determinación de la infiltración de la médula ósea es fundamental) o el mieloma. Por último, aunque no de forma generalizada, es creciente el uso en sarcomas ya que puede aportar información adicional para la caracterización y gradación tumoral, la guía de biopsia, la estadificación y reestadificación, y la evaluación de la respuesta al tratamiento neoadyuvante y de nuevos fármacos en ensayos clínicos (AU)

Positron emission tomography/computed tomography (PET/CT) is a hybrid imaging technique that combines the anatomic information from CT with the metabolic information acquired from PET after the administration of specific radiotracers, the most commonly used of which is F18-fluorodeoxyglucose (FDG). In oncology, this technique is based on the increased uptake of FDG by malignant lesions. In the locomotor apparatus, some uptake by bones and soft tissues is physiological or benign and this uptake must be differentiated from uptake by malignancies, whether primary or secondary. The most important limitations are active inflammatory or infectious processes, which are positive on PET images, and malignant lesions that are smaller than 1cm, cystic, necrotic, or low-grade, which are negative on PET images. PET/CT in the locomotor apparatus is especially useful for the detection of metastases from the most common tumors. It is also used for staging and monitoring the response to treatment of some hematological tumors like lymphoma, where it is fundamental to determine whether the bone marrow has been infiltrated, or myeloma. Lastly, although it is not yet an established indication, PET/CT is being increasingly used to study sarcomas, because it can provide additional information that can be useful for the characterization and grading of tumors, for guiding biopsies, for staging and re-staging, and for evaluating the response to neoadjuvant therapy as well as for evaluating new drugs in clinical trials (AU)

Versatilidad del colgajo de perforantes de la arteria sural y planificación quirúrgica mediante angioscanner / Versatility of sural artery perforator flap and surgical planning with angioscanner

La cirugía reconstructiva moderna busca incesantemente lograr la mejor cobertura bajo la mínima morbilidad de la zona donante. El objetivo de esta revisión y serie prospectiva es mostrar la versatilidad del colgajo de perforantes de la arteria sural medial y lateral para la cobertura de diferentes defectos empleado tanto de forma local como libre. Paralelamente, analizamos el valor del angioTAC en la planificación prequirúrgica de dicho colgajo. Exponemos nuestra experiencia reciente, de 2 años, con 11 casos de utilización del colgajo de perforantes de la arteria sural (SAP). Introducimos el uso del angioscanner como herramienta de planificación quirúrgica para la localización de las perforantes y diseño del colgajo. Concluimos que el colgajo SAP es una opción reconstructiva efectiva y fiable y que el angioTAC prequirúrgico es lo suficientemente útil como para realizarse de forma protocolaria (AU)

The modern reconstructive surgery continuously searches the best coverage option with minimal donormorbidity. Our goal with this prohespective series and revisionis to show how versatile sural artery perforator flap can be and the assistance with angioTAC as presurgical planning tool. We describe our experience in 2 years with 11 cases of using of the sural artery perforator flap. We also introduce the using of angioscanner as a presurgical planning tool to identify and design the flap. We conclude that sural artery perforator flap (SAP) is an effective and reliable reconstructive fasciocutaneous option and that angioTAC is a helpful-planning tool that confers suitability to be indicated (AU)

The role of plastic surgery in sarcoma treatment

INTRODUCTION: Sarcomas are low-incidence tumours, but their poor prognosis and complex treatment require the work of a multidisciplinary medical team. The Plastic Surgery Service forms part of the Sarcoma Functional Unit in our centre, performing tumour exeresis as well as immediate reconstruction. MATERIALS AND METHODS: We present a retrospective study on the experience of the Plastic Surgery Service of the Hospital Universitario de Bellvitge in the treatment of 133 sarcomas over 20 years. RESULTS: The surgical treatment was based on local radical surgery supported by primary reconstructive surgery in 42.9% of the cases, with an amputation rate in limb sarcomas of 9.7%. Radiotherapy and chemotherapy were used in the high-grade sarcomas as adjuvant treatment. The anatomical location of the head and neck was associated with the need for reconstructive procedures. Survival free from local recurrence was 84.72% at 5 years. Disease-specific survival was 81.22% at 5 years. The only prognostic factor for survival in our series was histological grade. CONCLUSIONS: Primary reconstructive surgery has a fundamental role in sarcoma treatment enabling radical surgical resection, avoiding amputations and facilitating adjuvant treatments (AU)