Microsurgical approach for unusual and unexpected malignant fibrous histiocytoma of the forearm: A case report

Abstract

Soft tissue sarcomas are rare tumors with a dismal prognosis. Among the most common histological types of sarcomas of the extremities, malignant fibrous histiocytoma (MFH) is the one with the highest incidence. Surgery is considered to be the first choice of treatment for MFH. To the best of our knowledge, this is the first case report in the literature of a patient with MFH within the abductor pollicis longus (APL) muscle. This unusual location was also unexpected by the treating surgeons, as the preoperative magnetic resonance imaging localized the tumor inside a different muscle. A 79-year-old Caucasian man presented with a swelling in the middle third of the dorsal aspect of the left forearm. MFH was diagnosed following biopsy and instrumental diagnostic examinations. Surgical excision and simultaneous reconstruction was performed by the same microsurgical team, achieving an excellent functional outcome. The present case highlights the significance of microsurgical approach for improving strategic planning in oncologic surgery. Accurate surgical dissection, performed by a team of microsurgeons, allowed for the identification of the unusual and unexpected tumor localization within the APL muscle. For this reason, a change of surgical strategy allowed for preservation of the extensor digitorum communis muscle, which would otherwise have to be resected, with tendon transfer and successful restoration of the thumb abduction function.

Simultaneous reconstruction of the forearm extensor compartment tendon, soft tissue, and skin

“…Recent 5-year survival rates approaching 80% demand reconstruction techniques that are both aesthetically and functionally successful [ 8 , 9 ]. Limb-preserving operations showed no significant differences compared with amputation in terms of overall survival and disease-free interval [ 10 ]. Surgical outcomes need to be assessed both in terms of their oncological results and based on a consideration of the functional outcomes.…”

Use of loupes magnification and microsurgical technique in thyroid surgery: ten years experience in a single center

“…Based on our more than thirty years' experience in other fields of general microsurgery (limb replantation, microvascular free flap, vasectomy reversal and seminal tract reconstruction, inferior laryngeal nerve reconstruction, etc.) (8,(20)(21)(22)(23)(24)(25)(26)(27), we believe that the use of the operating microscope during thyroid surgery might be replaced by 4.5x loupes which allows a larger operating field with consequent benefits in surgical procedures and patients outcome. Moreover, the use of the operating microscope also allows recording which has obvious benefits for both teaching purposes and for a medico-legal standpoint (4).…”

“…Our experience in many areas of general surgery and reconstructive microsurgery (8,(20)(21)(22)(23)(24)(25)(26)(27), has prompted us to consider the benefits related to the application of microsurgical technique and the use of loupes in neck surgery. Therefore, the aim of the present retrospective study was to review ten years of thyroid surgery performed with use of loupes magnification and microsurgical technique by our team in a single institution and analyze the outcomes with respect to those reported in the literature with other surgical techniques.…”