Amputação interescapulotorácica sob anestesia locorregional

Stewart-Treves syndrome: a case report

“…(2) In the present case, it was possible to observe a 12-year evolution, much higher than what has been described so far, the patient's clinical condition and the interventions performed may have contributed to the favorable evolution and survival presented. Treatment possibilities have limited success, being individualized on a case-by-case basis, ranging from large resections, amputation or disarticulation, such as the Berger surgery, (7) being indicated in the condition of large tumors intimately connected to the main nerves or to the vascular supply of the upper limb, as is the case of Stewart-Treves syndrome. (6) Interscapulothoracic disarticulation is performed after anesthesia, intubation and bladder catheterization of the patient, the surgical technique consists of positioning the patient in total lateral decubitus, with a medial incision being made in the sternoclavicular joint, extending laterally along the clavicle and bending down towards the posterior axillary line.…”

“…Finally, the serratus anterior muscle is divided at its origin on the thoracic wall, completing the entire resection, obtaining bone, vascular, lymphatic limits and approximation by contiguity of the surgical specimen, thus justifying the need for scapulectomy. (7,8) Chemotherapy therapy can be beneficial when there is a response to the first treatment, radiotherapy is reserved for patients with severe clinical instability or palliative and supportive conditions, the chemotherapy drugs used are: 5-fluorouracil, methotrexate, bleomycin and/or a combination of actinomycin D, vincristine, doxorubicin and cyclophosphamide. (3) Recent studies have demonstrated, through immunohistochemical staining of IL-23 and IL-17, the presence of IL-23 and IL-27 producing cells, important for tumor angiogenesis, in addition to promoting neoplastic advancement by blocking apoptosis, as well as attracting neutrophils and macrophages supporting the formation of cytokines and vascular endothelial growth factors in the injured tissue.…”