Sarcoma of the Lower Limb: Reconstructive Surgeon's Perspective

Zhixue, Lim; Strike, Sophia A.; Puhaindran, Mark E.

doi:10.1055/s-0039-1688101

Cited by 7 publications

(6 citation statements)

References 54 publications

(53 reference statements)

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“…When nerve transfer is not possible, the use of the local tendons, including the gracilis, tensor fasciae latae (TFL), sartorius, adductor longus, and hamstrings, has also been described (Table 2 ). 3 , 8 , 9 Using these relatively weak and sometimes antagonistic tendons for quadriceps reconstruction may seem counterintuitive, as they would likely not fully restore muscle strength or active range of motion. However, prominent quadricep activation during synergy A suggests these muscles’ role in ambulation is providing knee stability so that the forward momentum from the preceding swing can be conserved during stance.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction

Magrath

Qiu

Hanwright

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Functional lower extremity reconstruction primarily aims to restore independent ambulation. We sought to define the synergies recruited during a walking gait to inform donor selection for various motor deficits. With these findings, we discuss the functional neuromuscular components of independent gait with the goal of informing lower extremity reconstruction. Methods: A systematic review was performed using MEDLINE for articles published between January 2000 and December 2020. Search terms included (1) “motor module(s),” “synergy,” “motor pattern,” or “motor primitive” and (2) “gait,” “walking,” “ambulation,” or “locomotion.” Abstracts/full texts were reviewed by two independent reviewers. Results: A total of 38 studies were selected. The average reported number of synergies and variance accounted for was 4.5 ± 0.9 and 88.6% ± 7.7%, respectively. Four motor modules were conserved across nearly all studies. Conclusions: Walking can be reduced to the sequential activation of four motor modules. Activities during the stance phase are critical for both standing stability and forward progression and should be prioritized for reconstruction with the goal of preserving efficient gait. Muscles recruited during swing, except those used for ankle dorsiflexion, are less prone to injury and benefit from greater redundancy, less often necessitating reconstruction. With the emphasis on stability during stance, several synergistic or sometimes even antagonistic tendons can be used to replace their counterparts and restore efficient, independent ambulation. With a finite supply of donor tissues, and in the absence of well-defined clinical outcomes data, this research allows us to effectively prioritize reconstructive goals and maximize patient outcomes.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction

Magrath

Qiu

Hanwright

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Thanks to sarcoma treatment improvement, the necessity for amputation has been reduced, but it maintains a fundamental role in certain cases [ 18 ]. At the same time, rotationplasty remains a viable option when limb-salvage is contraindicated [ 19 ], or if the distal femoral growth plate has to be sacrificed with consequent major limb length discrepancy [ 20 ]. The distal femoral growth plate of the patient was free from disease, and it was planned to spare it during surgery.…”

Section: Discussionmentioning

confidence: 99%

A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case

et al. 2021

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For patients too young to be fitted with an expandable prosthesis, limb salvage surgery requires other strategies. The main problems are related to the impossibility of implanting an expandable prosthesis to the residual bone growth that is much too big in relation to the bone size, with the precocious implant loosening and/or the residual absence of bone growth, as well as the problem of limb length and shape difference. In this paper, we report a possible reconstruction solution using a composite prosthesis for an Ewing’s sarcoma of the proximal femur in an infant patient. After resection, a femoral stem was cemented into the distal third of a homoplastic humerus; a carbon fiber plate was used to stabilize the bone/homograft interface. At the one-year follow-up, the patient was free of disease and able to walk with only a slight limp. This case report describes a possible solution for very small patients. An adult humerus is of the right size to replace a child’s lower limb segments, and the distal humerus can be shaped, maintaining a cortex stiff enough to support a prosthesis. Very young patients might obtain a faster osteointegration of the graft than adults, due to their higher biological activity and, in this case, the diapasonal shape of the allograft might also have contributed to accelerated fusion. Moreover, the use of a graft to fit the prosthesis avoids loosening issues due to canal widening, hypothetically providing more growing time before system failure and revision surgery. However, although this technique is promising, further studies are necessary to confirm our findings and to verify if this procedure allows easier future prosthesis implantation.

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“…Soft tissue sarcomas account for<1% of the overall human burden of malignant tumors but remain life-threatening, and approximately 40% of patients with newly diagnosed soft tissue sarcoma die of the disease, corresponding to approximately 4,000 deaths each year in the United States. 3 Soft tissue sarcoma, diagnosed at an early stage, is eminently curable. When diagnosed at the time of extensive local or metastatic disease, it is rarely curable.…”

Section: Discussionmentioning

confidence: 99%

A unique case of classic pleomorphic sarcoma restricted to the toes

Siddiqui¹,

Akbar²

2021

Int Surg J

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Over 50% of soft tissue sarcomas occurring in older adults are histologically pleomorphic and high grade. Most have traditionally been classified as malignant fibrous histiocytoma (MFH). MFH was originally defined as a malignant pleomorphic spindle cell neoplasm showing fibroblastic and histiocytic differentiation. More recently, pathologists have accepted that this morphology may be shared by a wide range of malignant neoplasms. Many sarcomas that were previously classified as pleomorphic MFH, on careful immunohistochemical and histopathologic analyses, revealed a specific line of differentiation and could be reclassified as myxofibrosarcoma (30%), myogenic sarcoma (30%), liposarcoma (4%), malignant peripheral nerve sheath tumor (2%), or soft tissue osteosarcoma (3%), whereas about 30% had no specific line of differentiation or were myofibroblastic. The term undifferentiated pleomorphic sarcoma (UPS) is now reserved for pleomorphic sarcomas that show no definable line of differentiation by current technology. The majority of extremity sarcomas occur in the lower extremity (74 vs. 26% in the upper limb). According to one of the studies conducted on 315 patients, non-metastatic soft tissue sarcoma of the lower extremity who were treated at one institution over a ten-year period. Sixty-six percent of the lesions were above the knee, and 60% were high grade. This case had a 3x3 cm ulcer at the 3rd toe in a 30-year-old male patient who subsequently underwent midfoot ampuatation.

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Sarcoma of the Lower Limb: Reconstructive Surgeon's Perspective

Cited by 7 publications

References 54 publications

A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction

A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction

A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case

A unique case of classic pleomorphic sarcoma restricted to the toes

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