[Vascular reconstruction for limb preservation during sarcoma surgery: a case series and a management algorithm]. / Reconstrucción vascular durante la cirugía de sarcomas para la preservación de extremidades: serie de casos y algoritmo de manejo.

OBJECTIVE: To evaluate the results of vascular reconstruction in soft tissue sarcoma surgery and establish an algorithm based on current evidence. MATERIAL AND METHODS: We studied patients undergoing soft-tissue sarcoma in a tertiary hospital. A retrospective review of 8 cases was carried out, analysing the demographics, surgical planning, complications, disease-free survival and bypass patency. RESULTS: Successful limb preservation was observed in all patients, and the bypass remained patent in all cases. The mean follow-up was 38.4 months average, with 87.5% survival and no recurrences. CONCLUSIONS: The involvement of major vascular structures in soft tissue sarcomas of the limbs does not necessarily exclude resectability. In selected cases, resection is possible with vascular reconstruction and limb preservation. However, multidisciplinary planning is needed.

Reconstrucción vascular durante la cirugía de sarcomas para la preservación de extremidades: serie de casos y algoritmo de manejo / Vascular reconstruction for limb preservation during sarcoma surgery: A case series and a management algorithm

Objetivo. Valorar los resultados de las reconstrucciones vasculares en la cirugía de sarcomas de partes blandas y establecer un algoritmo de actuación con base a la evidencia actual. Material y métodos. Se han estudiado los pacientes intervenidos de sarcoma de partes blandas en un hospital terciario. Revisión retrospectiva de 8 casos; ha sido analizado: la demografía, la planificación quirúrgica, las complicaciones, la supervivencia libre de enfermedad y global, y la permeabilidad del bypass. Resultados. Se ha objetivado que todos los pacientes han preservado la extremidad y el bypass ha permanecido permeable en todos los casos. El seguimiento fue de 38,4 meses de media, con el 87,5% de supervivencia y ausencia de recidivas. Conclusiones. El envolvimiento de estructuras vasculares principales en los sarcomas de partes blandas en extremidades no necesariamente impide la resecabilidad. En los casos seleccionados es posible la resección con reconstrucción vascular y preservación de extremidad. No obstante, es necesaria una correcta planificación multidisciplinar (AU)

Objective. To evaluate the results of vascular reconstruction in soft tissue sarcoma surgery and establish an algorithm based on current evidence. Material and methods. We studied patients undergoing soft-tissue sarcoma in a tertiary hospital. A retrospective review of 8 cases was carried out, analysing the demographics, surgical planning, complications, disease-free survival and bypass patency. Results. Successful limb preservation was observed in all patients, and the bypass remained patent in all cases. The mean follow-up was 38.4 months average, with 87.5% survival and no recurrences. Conclusions. The involvement of major vascular structures in soft tissue sarcomas of the limbs does not necessarily exclude resectability. In selected cases, resection is possible with vascular reconstruction and limb preservation. However, multidisciplinary planning is needed (AU)

Use of angioscanning in the surgical planning of perforator flaps in the lower extremities.

BACKGROUND: This is one of the few studies in the literature to describe angio-computed tomography (CT) as a planning tool in perforator flap surgery in the lower extremities. METHODS: Eighteen consecutive patients undergoing a perforator flap for lower-extremity reconstruction underwent preoperative CT angiography between September 2007 and November 2009. Eleven received propeller-type flaps, four medial sural artery perforator (MSAP) flaps, two lateral sural artery perforator (LSAP) flaps and one anterolateral thigh (ALT) flap. RESULTS: Preoperative CT angiography was highly specific (100%) and sensitive in mapping and visualising perforators in the lower limb. There were hardly any flap failures after angio-CT, and operative findings always correlated perfectly with preoperative imaging. Postoperative recoveries were uneventful except in three cases of peroneal artery perforator flaps that presented partial necrosis due to venous congestion. CONCLUSIONS: CT angiography is a valuable imaging tool for the preoperative assessment of the donor-site vascular supply for lower-extremity flaps. We recommend use of preoperative angio-CT for imaging vascular anatomy of the lower limb before defect reconstruction, especially in traumatic patients and patients with peripheral vascular disease. Its use can also reduce intra-operative dissection time and minimises surgical error in the identification of the vascular anatomy.

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)