Soft-tissue complications of intra-arterial chemotherapy for extremity sarcomas
| Autor: | H. P. Bezwada, Mark S. Granick, J. H. Moore, C. D. Long, A. J. Weiss, R. L. Lackman |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Adult
medicine.medical_specialty Soft Tissue Injuries medicine.medical_treatment Chondrosarcoma Sarcoma Ewing Surgical Flaps Necrosis Sarcoma Synovial Antineoplastic Combined Chemotherapy Protocols medicine Humans Infusions Intra-Arterial Fat necrosis Osteosarcoma business.industry Soft Tissue Infections Soft tissue Extremities Middle Aged medicine.disease Synovial sarcoma Surgery Plastic surgery medicine.anatomical_structure Amputation Doxorubicin Female Sarcoma Cisplatin business Floxuridine Subcutaneous tissue |
| Zdroj: | Annals of plastic surgery. 40(4) |
| ISSN: | 0148-7043 |
| Popis: | High-grade sarcomas have a high rate of local recurrence as well as distant metastases. This has led to the development of intra-arterial chemotherapy (IAC) as part of a multimodal approach to control local disease and/or reduce the extent of surgical resection. Intra-arterial catheters are positioned by an interventional radiologist into the feeding vessels of the tumor. Adriamycin and 5-fluorodeoxyuridine are infused intra-arterially. Cisplatinum, with or without granulocyte colony stimulating factor, is given systemically. Patients usually experience acute self-limited soft-tissue inflammation in the treated area. In our experience of 118 patients, 3 patients experienced soft-tissue necrosis that required excision and reconstruction. The first was treated for synovial sarcoma of a metatarsal. After IAC with Adriamycin, she sloughed the skin, subcutaneous tissue, and some of the posterior compartment musculature of her calf. This tissue was debrided. A gastrocnemius flap and skin graft were used for coverage. She is free of disease and ambulatory. The second patient was treated with IAC Adriamycin for a radial head chondrosarcoma. She developed soft-tissue slough, which became infected with Pseudomonas. She required extensive debridement of the skin, subcutaneous tissue, and muscle, and was subsequently reconstructed with a latissimus flap and a split-thickness skin graft (STSG). She later developed a local recurrence requiring amputation. The latissimus was elevated and used to cover the distal stump. She also is free of disease. The third patient was treated with IAC Adriamycin for Ewing's sarcoma of the right femur. This was complicated by fat necrosis and persistent pain. Subsequent radiotherapy only worsened her symptoms. She underwent wide excision and muscle flap/STSG repair, which relieved her pain. She is currently ambulatory and free of disease. In conclusion, as the use of IAC continues, its complications may become more common. Our experience with this previously unknown entity is illustrated and therapeutic options are discussed. |
| Databáze: | OpenAIRE |
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