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Excision of soft tissue sarcoma in extremity


Medical editor Ole Jacob Norum MD
Orthopedic Surgeon
Oslo University Hospital

Raphael Pollock, MD, PhD
MD Anderson Cancer Center

General

Most soft tissue sarcomas can be removed with limb-sparing surgery; it is rarely necessary to amputate.

Soft tissue sarcoma grows proximally and distally within the same muscle group, it rarely penetrates the fascia.

The most frequent localization is front and dorsal aspect of the thigh, upper arm/shoulder and trunk wall.

Previously, it was normal to remove the entire muscle group to avoid local recurrence. More recently, it has become more common to only resect parts of the muscle group. During planning, it is decided which margin is necessary. Determining factors are the malignancy grade, proximity to surrounding structures, and growth patterns.

Indications

  • Soft tissue sarcomas

Goal

  • Cure the disease

Equipment

  • Surgical soft tissue instruments
  • Instruments for vessel resection and necessary vessel prostheses 
  • For free vascular flaps, it is necessary to have microinstruments
  • Equipment for a skin transplantation may be necessary.

Preparation

  • The surgery is planned precisely and the position of the patient on the operation table is determined.
  • If possible, the specific exercises which will be relevant after the surgery should be practiced preoperatively.
  • Antibiotic prophylaxis is given large, deep tumors
  • Thrombosis prophylaxis is given.

 


Implementation

  • An incision is made to obtain good overview and access.
  • Usually, important nerves and vessels are conserved, but in some cases these structures must be removed. Vessels can be replaced with artificial ones.
  • Excision of tumor with surrounding tissue should be done with wide margins, and all previous biopsy canals and potentially contaminated tissue must be removed within the surgical specimen.
  • A vacuum drain is applied.
  • The skin is closed with sutures or possibly with a skin transplant or flap plastics.




Follow-up

  • For surgery in lower extremities, the leg is raised during the first days after the procedure to avoid edema.
  • The patient should have daily physical therapy, often 2-3 times per day according to guidelines given by orthopedist regarding mobilization, strain, and exercises.
  • Fluid accumulation from the wound will follow and the drain will be removed when this diminishes.
  • Observe for signs of infection.

Follow-up visits

The patient should be monitored by the surgeon after the incision has healed, the function in the extremity is satisfactory, and pain is gone.

Seroma (fluid collection in the wound cavity) is a normal complication and may occur a few weeks after the operation. It is not uncommon to aspirate multiple times.


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