Upper Extremity Considerations for Oncologic Surgery

Wong, Justin C.; Abraham, John A.

doi:10.1016/j.ocl.2014.06.007

Cited by 14 publications

(13 citation statements)

References 111 publications

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“…1 However, larger defects and cases of impaired vasculature require biomaterials, endoprostheses, and vascularized bone transfers. [2][3][4][5] The workhorse of upper extremity long-bone reconstruction is the free vascularized fibula graft. 6 The fibula compares favorably to the iliac crest and rib bone grafts due to its more suitable properties, including its diaphyseal straightness.…”

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confidence: 99%

Free Vascularized Fibular Graft is Reliable in Upper Extremity Long-Bone Reconstruction with Good Long-Term Outcomes

Repo

Sommarhem

Roine

et al. 2016

J reconstr Microsurg

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Background Free vascularized fibular graft is useful in upper extremity long-bone reconstruction. The authors studied the reliability and long-term outcomes of this technique. Methods The authors included 20 patients with a minimum follow-up of 24 months in this study, and retrospectively reviewed patients' hospital records and used a preinformation form, the Disabilities of the Arm, Shoulder and Hand (DASH), the Lower Extremity Functional Scale (LEFS), and the 15D health-related quality of life (HRQoL) instrument to perform a cross-sectional assessment. Results A total of 9 adults and 11 children underwent vascularized fibular transfer for radical tumor resection (n = 13), infection (n = 1), injury (n = 3), or secondary pseudoarthrosis (n = 3) in various locations of the upper extremity. The median follow-up period was 6 years. Six reoperations proved necessary: one early reanastomosis and five revisions with cancellous bone grafting to enhance union. Altogether, 19 of the 20 grafts survived: one graft failed due to infection. One arm was amputated due to tumor recurrence. The median duration of bone union was 12 months. One graft never achieved distal union, whereas another developed nonunion after a stress fracture. Ten patients completed the questionnaires, with a median of 15.3 years postoperatively. The results revealed functional capabilities ranging from no restrictions to significantly impaired, and an HRQoL comparable to that of an age-standardized general population. Conclusion The free vascularized fibular graft is viable in different age groups to reconstruct upper extremity long-bone defects in cases of radical bone resection, extensive injury, and diaphyseal pseudoarthrosis. The long-term outcomes support the use of this technique.

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confidence: 99%

Free Vascularized Fibular Graft is Reliable in Upper Extremity Long-Bone Reconstruction with Good Long-Term Outcomes

Repo

Sommarhem

Roine

et al. 2016

J reconstr Microsurg

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“…This finding emphasizes the notion that lymph node involvement acts as an independent factor leading to unfavorable survival, especially for upper limb patients. Present diagnostic strategy for lymph node involvement is thorough imaging examinations, including PET-CT and bone scans (28)(29)(30). Axillary lymphadenectomy is not primarily recommended to prevent lymph involvement in upper limb osteosarcoma patients for the low prevalence of lymph involvement (30).…”

Section: Discussionmentioning

confidence: 99%

Regional lymph node involvement is associated with poorer survivorship in patients with upper extremity osteosarcoma than with lower extremity osteosarcoma: a SEER analysis

Xie¹,

Zeng²,

Tu³

et al. 2020

Transl Cancer Res TCR

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Background: Although the upper limb is the second most common site of osteosarcoma, investigations into clinical manifestation differences between upper and lower limb patients are still sporadic. We retrospectively investigated the characteristics of these patients to gain a better understanding of the differences between upper and lower limb osteosarcoma patients.Methods: This retrospective study involved patients diagnosed with extremity osteosarcoma between 1997 and 2016 collected from the Surveillance, Epidemiology, and End Results (SEER) database. Patient characteristics were analyzed with t-tests, rank sum tests and chi-square tests. Log-rank tests were applied to evaluate univariate significance, and Cox hazards models were performed in multivariate analysis. A binary logistics regression model was used to screen the risk factors related to lymph node involvement.Results: In total, 1,882 patients, 1,588 (84.4%) with lower limb lesions and 294 (15.6%) with upper limb lesions were enrolled in our study. The patients with upper limb osteosarcoma exhibited poorer 5-year overall survival (OS) than patients with lower limb osteosarcoma (54.8% vs. 63.2%, P=0.02). The upper limb patients had more lymph node involvement (5.6% vs. 2.7%, P=0.03), which was found to be an independent prognostic factor (P=0.000). Tumors located in the upper limbs and the presence of distal metastasis were risk factors related to lymph node involvement in the extremity (P<0.05). The upper limb patients were tended to suffer greater risk of being affected by both metastasis and lymph node involvement (15.7% vs. 9.4%, P=0.18).Conclusions: Upper limb osteosarcoma patients are characterized by more lymph node involvement than lower limb patients, leading to poorer OS. In addition, upper limb patients are at greater risk for both lymph node involvement and distal metastasis. Our results suggest that upper limb patients should be screened more thoroughly for regional lymph node involvement.

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“…The spectrum of associated surgical techniques involves flaps (local, regional, distant and free flaps) and split-thickness or full-thickness skin grafts (6). The specific techniques selected are dependent on a comprehensive evaluation of the defect size and depth, the location of tumor, the tumor proximity to neurovascular structures and the overall health status (30). In the current study, NPWT allowed for secondary soft-tissue reconstruction for cases with a high risk of post-operative wound complications.…”

Section: Discussionmentioning

confidence: 99%

Use of negative pressure wound therapy as an adjunct to the treatment of extremity soft-tissue sarcoma with ulceration or impending ulceration

Chen

et al. 2016

Oncology Letters

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Abstract. Major wound complications of the extremities, following wide tumor resection and reconstruction for soft-tissue sarcomas (STSs), remain a challenge for limb-sparing surgery. Furthermore, STSs with ulceration or impending ulceration predispose patients to an increased risk of post-operative infection. The present study was conducted to assess the efficacy of negative pressure wound therapy (NPWT) in preventing wound complications associated with surgical treatment of STSs with ulceration or impending ulceration, in patients treated between February 2012 and January 2013. A total of 5 patients, with a mean age of 48 years (range, 24-68 years), were enrolled in the present study. The diagnoses consisted of undifferentiated pleomorphic sarcoma (n=2), leiomyosarcoma (n=1), synovial sarcoma (n=1) and epithelioid sarcoma (n=1). According to American Joint Committee on Cancer criteria, 3 cases were stage III tumors, and the remaining 2 cases were of stages ⅡA and ⅡB, respectively. A total of 3 patients exhibited ulceration at diagnosis, and the remaining patients demonstrated impending ulceration. The mean wound area following wide resection of the tumor was 73 cm 2 (range, 45-110 cm 2 ). A continuous suction mode, with pressures measuring -200 to -300 mmHg, was used for 7-10 days on the soft-tissue defects as preparation for wound closure. Soft-tissue reconstruction included muscle flaps (n=2) and skin grafts (n=5). No major wound complications occurred. Post-operative functional and cosmetic outcomes were acceptable. A single patient demonstrated local recurrence 12 months after surgery and re-excision of the tumor was performed. All patients remained alive at the conclusion of follow-up, with a mean follow-up time of 26 months (range, 12-36 months). The present study demonstrated that NPWT is effective and safe when used as an adjunct to wound closure following resection of extremity STS with ulceration/impending ulceration.

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Upper Extremity Considerations for Oncologic Surgery

Cited by 14 publications

References 111 publications

Free Vascularized Fibular Graft is Reliable in Upper Extremity Long-Bone Reconstruction with Good Long-Term Outcomes

Free Vascularized Fibular Graft is Reliable in Upper Extremity Long-Bone Reconstruction with Good Long-Term Outcomes

Regional lymph node involvement is associated with poorer survivorship in patients with upper extremity osteosarcoma than with lower extremity osteosarcoma: a SEER analysis

Use of negative pressure wound therapy as an adjunct to the treatment of extremity soft-tissue sarcoma with ulceration or impending ulceration

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