Management of a Complex, Recurrent Case of Medial Thigh Sarcoma With Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Lymphatic Flow-Through (LyFT) Flap and Secondary Anterolateral Thigh (ALT) Free Flap With Innervated Vastus Lateralis Anastomosed to Synthetic Artery Graft: A Case Report

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-09-02 DOI:10.1002/micr.31224
Federica Martini, Matteo Meroni, Mario F. Scaglioni
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引用次数: 0

Abstract

Soft-tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin and account for only 1% of adult malignancies. They tend to occur most commonly in the lower extremities. Reconstruction after sarcoma resection can be challenging, especially when important structures are involved and recurrences occur. Additionally, more attention is now being paid to reconstructing the lymphatic system to prevent lymphatic complications. In this case report, we presented the management of recurrent medial thigh sarcoma that necessitated multiple challenging reconstructions to provide valuable insights for lectures on similar cases. A 50-year-old male patient was diagnosed with an undifferentiated pleomorphic cell sarcoma (UPS) of the anteromedial thigh. After preoperative radiotherapy, a mass of 23 × 15 cm was removed, and reconstruction with a pedicled deep inferior epigastric artery perforator (p-DIEP) flap-based lymphatic flow through (LyFT) was performed. Six months later, the patient developed the first local recurrence with the presence of a distant metastasis. Following the tumor resection, the medial part of the DIEP flap was de-epithelized and buried in the defect for dead space obliteration. Another local recurrence arose 7 months after the second surgery. Therefore, a major debulking surgery involving the femoral neurovascular bundle was performed. The femoral artery was reconstructed with a synthetic graft, and the femoral vein with the great saphenous vein harvested from the contralateral thigh. A composite myocutaneous neurotized anterolateral thigh (ALT) flap from the contralateral thigh was used to obliterate the defect and restore the loss of function of the quadriceps femoris. Two lymphaticovenular anastomoses (LVAs) were performed at the ankle to reduce the risk of lymphatic sequelae. This case report highlights the importance of integrating various techniques to create a tailored approach that effectively addresses complex surgical requirements to avoid limb amputation and maintain functionality.

使用带蒂深腹外动脉穿孔器 (DIEP) 淋巴管穿行 (LyFT) 皮瓣和带有与合成动脉移植物吻合的神经支配的大腿前外侧 (ALT) 游离皮瓣治疗复杂的大腿内侧肉瘤复发病例:病例报告。
软组织肉瘤(STS)是一种罕见的间质细胞来源实体瘤,仅占成人恶性肿瘤的 1%。它们最常发生在下肢。肉瘤切除术后的重建具有挑战性,尤其是在涉及重要结构和复发的情况下。此外,现在人们更加关注淋巴系统的重建,以防止淋巴并发症的发生。在本病例报告中,我们介绍了复发性大腿内侧肉瘤的治疗方法,该病例需要进行多次具有挑战性的重建,为类似病例的讲座提供了宝贵的见解。一名 50 岁的男性患者被诊断为大腿前内侧未分化多形性细胞肉瘤(UPS)。术前放疗后,切除了一个 23 × 15 厘米的肿块,并用带蒂的下腹深动脉穿孔(p-DIEP)皮瓣进行了基于淋巴流过(LyFT)的重建。六个月后,患者首次出现局部复发,并伴有远处转移。肿瘤切除后,DIEP皮瓣的内侧部分被去表皮并埋入缺损处,以消除死腔。第二次手术后 7 个月,再次出现局部复发。因此,又进行了一次涉及股神经血管束的大切除手术。用人工合成移植物重建了股动脉,用从对侧大腿采集的大隐静脉重建了股静脉。使用对侧大腿的复合肌皮神经化大腿前外侧(ALT)皮瓣来消除缺损,恢复股四头肌的功能。在脚踝处进行了两处淋巴管-静脉吻合术(LVA),以降低淋巴管后遗症的风险。本病例报告强调了整合各种技术的重要性,以创建一种量身定制的方法,有效解决复杂的手术要求,避免截肢并保持功能。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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