Soft Tissue Sarcomas of the Foot and Ankle: Impact of Unplanned Excision, Limb Salvage, and Multimodality Therapy

2008 ◽  
Vol 29 (7) ◽  
pp. 690-698 ◽  
Author(s):  
Mihir M. Thacker ◽  
Benjamin K. Potter ◽  
J David. Pitcher ◽  
H Thomas. Temple
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Soft Tissue Sarcomas ◽  
Multimodality Therapy ◽  
Foot And Ankle ◽  
Unplanned Excision

scholarly journals Limb salvage for soft-tissue sarcomas of the foot and ankle

2010 ◽  
Vol 92-B (3) ◽  
pp. 424-429 ◽  
Author(s):  
G. L. Cribb ◽  
S. C. S. Loo ◽  
I. Dickinson
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Soft Tissue Sarcomas ◽  
Foot And Ankle

Comparison of flap reconstruction for soft tissue sarcomas of the foot and ankle

2021 ◽  
Author(s):  
Katherine E. Mallett ◽  
Matthew T. Houdek ◽  
Rachel L. Honig ◽  
Karim Bakri ◽  
Peter S. Rose ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Flap Reconstruction ◽  
Foot And Ankle

Effect of unplanned excision of soft tissue sarcomas on skin defects and reconstructive procedures

2020 ◽  
Vol 54 (6) ◽  
pp. 372-376
Author(s):  
Hideki Tokumoto ◽  
Shinsuke Akita ◽  
Yoshitaka Kubota ◽  
Nobuyuki Mitsukawa
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Reconstructive Procedures ◽  
Skin Defects ◽  
Unplanned Excision

Surgical Strategies: Necrotizing Fasciitis of the Foot and Ankle Treated With Dermal Regeneration Matrix for Limb Salvage

2020 ◽  
pp. 107110072095208
Author(s):  
Arvind S. Narayanan ◽  
Kempland C. Walley ◽  
Todd Borenstein ◽  
G. Aman Luther ◽  
J. Benjamin Jackson ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Necrotizing Fasciitis ◽  
Limb Salvage ◽  
Free Flap ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Flap Coverage ◽  
Split Thickness Skin Grafting ◽  
Dermal Regeneration

Although necrotizing fasciitis is a life-threatening entity that needs expeditious treatment, cases involving the lower extremity are less commonly encountered than in the upper extremity. Surgical intervention is often required and likely lead to amputation (below-knee or above-knee) vs debridement in the lower extremity. Coverage options in the foot and ankle after serial debridements can present many challenges for limb salvage. Patients are often left with large soft tissue defects requiring coverage with a subsequent increase in relative morbidity. Treatment options for coverage in these cases include negative-pressure wound therapy, split-thickness skin grafting, free flap coverage, or higher-level amputation. In the diabetic population, who present with a lower extremity necrotizing infection, limb salvage is often a challenge given the multiple comorbidities associated with these patients including peripheral vascular disease, immunocompromised state, and neuropathy. Optimal treatment strategies for these necrotizing infections in the foot and ankle remain uncertain. We offer a technique tip for utilization of a dermal regeneration matrix to allow coverage of large soft tissue defect with exposed tendon and/or bone without the need for free flap coverage or higher-level amputation, thus allowing for an additional limb salvage option. Level of Evidence: Level V, expert opinion.

scholarly journals Preoperative Radiation Therapy Followed by Reexcision May Improve Local Control and Progression-Free Survival in Unplanned Excisions of Soft Tissue Sarcomas of the Extremity and Chest-Wall

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Hina Saeed ◽  
David M. King ◽  
Candice A. Johnstone ◽  
John A. Charlson ◽  
Donald A. Hackbarth ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Proportional Hazards Model ◽  
Performance Status ◽  
Soft Tissue Sarcomas ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Preoperative Radiation ◽  
Free Survival ◽  
Unplanned Excision

Background. The management for unplanned excision (UE) of soft tissue sarcomas (STS) has not been established. In this study, we compare outcomes of UE versus planned excision (PE) and determine an optimal treatment for UE in STS.Methods. From 2000 to 2014 a review was performed on all patients treated with localized STS. Clinical outcomes including local recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) were evaluated using the Kaplan-Meier estimate. Univariate (UVA) and multivariate (MVA) analyses were performed to determine prognostic variables. For MVA, Cox proportional hazards model was used.Results. 245 patients were included in the analysis. 14% underwent UE. Median follow-up was 2.8 years. The LR rate was 8.6%. The LR rate in UE was 35% versus 4.2% in PE patients (p<0.0001). 2-year PFS in UE versus PE patients was 4.2 years and 9.3 years, respectively (p=0.08). Preoperative radiation (RT) (p=0.01) and use of any RT for UE (p=0.003) led to improved PFS. On MVA, preoperative RT (p=0.04) and performance status (p=0.01) led to improved PFS.Conclusions. UEs led to decreased LC and PFS versus PE in patients with STS. The use of preoperative RT followed by reexcision improved LC and PFS in patients who had UE of their STS.

Re-excision after unplanned excision of soft tissue sarcomas: Long-term results

2020 ◽  
Vol 34 ◽  
pp. 212-217
Author(s):  
Guido Scoccianti ◽  
Matteo Innocenti ◽  
Filippo Frenos ◽  
Francesco Muratori ◽  
Federico Sacchetti ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Long Term Results ◽  
Unplanned Excision

The impact of multimodality therapy in marginally inoperable soft tissue sarcomas (STS): The Toronto Sarcoma Program Experience.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. 11051-11051
Author(s):  
Samer Salah ◽  
Anthony Lott ◽  
Peter Charles Ferguson ◽  
Jay Wunder ◽  
Abha A. Gupta ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Multimodality Therapy ◽  
The Impact

scholarly journals Incidence and Severity of Lymphoedema following Limb Salvage of Extremity Soft Tissue Sarcoma

Sarcoma ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Daniel Friedmann ◽  
Jay S. Wunder ◽  
Peter Ferguson ◽  
Brian O'Sullivan ◽  
David Roberge ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Functional Outcomes ◽  
Soft Tissue Sarcomas ◽  
Treatment Modalities ◽  
Adjuvant Radiation ◽  
Tumor Characteristics ◽  
Msts Score ◽  
Extremity Soft Tissue Sarcoma ◽  
Associated Risk Factors

Background and Purpose. Lymphoedema is a serious complication following limb salvage for extremity soft tissue sarcomas (STSs) for which little is known. We aimed to evaluate its incidence, its, severity and its associated risk factors.Material and Method. Patient and tumor characteristics, treatment modalities and complications and functional outcomes (MSTS 1987, TESS), and lymphoedema severity (Stern) were all collected from prospective databases. Charts were retrospectively abstracted for BMI and comorbidities.Results. There were 289 patients (158 males). Mean age was 53 (16–88). Followup ranged between 12 and 60 months with an average of 35 and a median of 36 months. Mean BMI was 27.4 (15.8–52.1). 72% had lower extremity tumors and 38% upper extremity. Mean tumor size was 8.1 cm (1.0–35.6 cm). 27% had no adjuvant radiation, 62% had 50 Gy, and 11% received 66 Gy. The incidence of lymphoedema was 28.8% (206 none, 58 mild, 22 moderate, 3 severe, and 0 very severe). Mean MSTS score was 32 (11–35) and TESS was 89.4 (32.4–100). Radiation dose was significantly correlated with tumorsize>5 cm (P=0.0001) and TESS score (P=0.001), but not MSTS score (P=0.090). Only tumorsize>5 cm and depth were found to be independent predictors of significant lymphoedema.Conclusion. Nine percent of STS patients in our cohort developed significant (grade≥2) lymphoedema. Tumorsize>5 cm and deep tumors were associated with an increased occurrence of lymphoedema but not radiation dosage.

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