Value of Drains in Soft-Tissue Tumour Surgery: A Specialist Regional Centre Experience.

Background The mainstay of therapy in most soft-tissue tumours (STTs) is excision. However, this often results in blood/extracellular fluid collection within large dead spaces necessitating the use of surgical drains. Whether meticulous attention to haemostasis, careful closure of dead space, and use of compression bandage obviates the need for drains was investigated. This study aimed to compare postoperative outcomes in patients undergoing surgery for STTs with and without the use of drains. Methodology A retrospective analysis of patients undergoing STT surgery over five years was undertaken using a regional STT specialist service database. Patients were stratified into the following two groups: compression bandage alone (CB) versus compression bandage with drain (CBD). The chi-square test was used to examine associations with infection, seroma, and haematoma, while the unpaired t-test was used for associations with hospital stay and time to wound healing. The unpaired t-test with Bonferroni correction was used to account for tumour dimensions across both groups. Results A total of 81 CB and 25 CBD patients were included. The mean hospital stay was significantly lower in CB compared to CBD (4.9 days, SD = 8.574 vs. 9.8 days, SD = 7.647, p = 0.0125). None of the other variables was significantly different between the two groups, including infection (21.3% vs. 24.0%, p = 0.7804), seroma (25.0% vs. 36.0%, p = 0.2865), haematoma (0.026% vs. 2.0%, p = 0.2325), and time to wound healing (55.8 days, SD = 63.59 vs. 42.3 days, SD = 58.88, p = 0.3648). Conclusions Our findings suggest that the use of drains in patients undergoing STT tumour surgery lengthens hospital stay without reducing the incidence of postoperative complications/time to wound healing. A larger, prospective trial is needed.

Painful swollen leg--think beyond deep vein thrombosis or Baker's cyst.

BACKGROUND: The diagnosis of deep vein thrombosis of leg is very common in clinical practice. Not infrequently a range of pathologies are diagnosed after excluding a thrombosis, often after a period of anticoagulation. CASE PRESENTATION: This is a report of three patients who presented with a painful swollen leg and were initially treated as a deep vein thrombosis or a baker's cyst, but later diagnosed as a pleomorphic sarcoma, a malignant giant cell tumor of the muscle and a myxoid liposarcoma. A brief review of such similar reports and the relevant literature is presented. CONCLUSION: A painful swollen leg is a common clinical scenario and though rare, tumors must be thought of without any delay, in a duplex negative, low risk deep vein thrombosis situation.

Soft tissue osteosarcoma: a case report.

Osteosarcomas arising from extraskeletal locations are extremely rare and their true prevalence is unknown. We describe a case of soft tissue-origin-osteosarcoma arising from the vastus medialis muscle in a 58-year old woman. The possibility of a malignant tumour was not suspected initially and she was referred to a specialist unit only one year after the onset of the swelling. She was successfully treated with a surgical resection, chemotherapy and radiotherapy. Because of the rarity of the tumour, a high degree of suspicion is required to make an early diagnosis. The differential diagnosis of a soft tissue mass located in the thigh in a patient over the age of 40 years, should include extraskeletal osteosarcoma.

Rhabdomyosarcoma of the extremities in adults.

Rhabdomyosarcomas are uncommon in adults and literature regarding their management is limited. Eight patients with an average age of 32.6 years (range: 21 to 75) who were treated for rhabdomyosarcomas on the extremities between 1991 and 2002 in a regional centre for the treatment of soft tissue sarcomas were studied retrospectively. Treatment consisted of en bloc resection of the primary tumour in all the patients, combined with radiotherapy or chemotherapy or both. The tumour size ranged from 5.5 cm to 15 cm (average 9.3 cm). Histologically there were four alveolar, two pleomorphic, one embryonal and one anaplastic subtype. Seven of the eight patients developed metastasis and died after an average period of 15.3 months (range 4-28 months). At the final follow-up, only one patient was disease free and alive 48 months after surgery. Extremity rhabdomyosarcoma is a highly malignant tumour and our results are poor compared to the reported results in children. Metastatic recurrence is high in adult rhabdomyosarcomas even with local control of the disease and therefore development of effective systemic therapy is an urgent priority.