Management of extremely hard‐to‐heal extremity wounds with severe life‐threatening complications

Abstract

The introduction of neoadjuvant radiotherapy has allowed limb-preserving surgical treatment in patients with extremity soft tissue sarcoma, and the overall prognosis of this approach is similar to that of limb amputation. The benefits of this treatment, however, are often accompanied with a higher risk of major complications and blood vessel damage because of radiation-induced inflammation and necrosis of the vessel wall. In particular, it is associated with the rupture of large vessels like the femoral artery and more severe complications of wounds located in the proximal lower extremity. We present a series of four patients with soft tissue sarcoma of the thigh undergoing tumour removal and reconstruction of the defect after neoadjuvant radiotherapy. The post-operative outcome depended on the total dose of radiation used as well as the closing technique of the resulting wound. Major wound complications occurred when the irradiated skin was closed directly over the resection cavity or when local skin flaps were used. In one case, severe radiation-induced life-threatening multiple bleeding events occurred, which led to multiple flap failures. Even if the skin cover is not a problem, we propose a combined interdisciplinary approach involving immediate plastic surgical transfer of healthy, well-vascularised tissue into a defect resulting from oncological resection of sarcoma of the lower extremity following neoadjuvant radiotherapy in order to avoid secondary wound breakdown and severe bleeding complications.

Transcriptional profile of in vitro expanded human epidermal progenitor cells for the treatment of non-healing wounds

“…It seems important, mainly due to the fact that oncological patients frequently undergo surgical procedures, where excessive tissue fragments can be obtained and used for research. Moreover, these patients usually require reconstructive treatment [44,45] but are overlooked in terms of cell therapies, even though many of them would benefit from such treatment. Our work shows that these people might be helped by therapies that use in vitro cultured cells.…”

Defect reconstruction of the trochanter major after necrotizing fasciitis and multiple operations using an arteriovenous loop and latissimus dorsi free flap

“…Basically, there are two different types of flaps regarding their vascularization: flaps perfused by a random pattern vascular pathway, also known as the extrinsic vascularization, and flaps, which rely on a vascular axis, so called intrinsically perfused flaps [11,12] . Furthermore, intrinsically perfused flaps can be transferred as pedicled flaps into the defect or can be transplanted using microsurgical techniques as free flaps to distant parts of the body [3,13] . Based on the reconstruction latter, in this case a rotational random pattern flap was performed first to reconstruct the lateral defect in the groin/hip area.…”

Use of Biologic Agents in Extremity Reconstruction

“…Most notably, patients who are smokers, have a history of radiation therapy, or who have peripheral artery disease are particularly susceptible to developing postoperative complications. 15 16…”

“…Most notably, patients who are smokers, have a history of radiation therapy, or who have peripheral artery disease are particularly susceptible to developing postoperative complications. 15,16 Superficial defects that spare the underlying musculature, tendons, and bone can often be reconstructed using splitthickness skin grafting (STSG) with acceptable results. 15 Larger superficial defects, however, frequently benefit from the addition of biologic wound agents prior to graft placement.…”