1/17. Bipedicled vascularized fibula flap for proximal humerus defect in a child.Vascularized bone transfer is becoming the most important option in the many cases in which durable, long-standing bone reconstruction is needed. The transfer of the vascularized epiphyseal plate, although controversial, is advantageous in cases where future growth is needed (i.e., congenital anomalies and tumor resections in children). The use of the free fibular head flap, based on epiphyseal blood supply augmentation, was reported using the anterior tibial artery, or part of it, as the nutritional vessel. By using both the peroneal artery and the specific branch to the fibular head as a bipedicled free flap, we ensured both long-bone fibula reconstruction and augmented blood supply to the head. We report a case of subtotal resection of the humerus due to osteosarcoma in a child that was reconstructed by this method. A preoperative study was conducted on fresh cadavers to identify the specific pedicle of the fibular head. The biceps femoris tendon was used to better stabilize the shoulder joint. The child recovered well and showed good progress in rehabilitation. On follow-up 1 year postoperatively, the shoulder joint remained limited, but showed no signs of substantial remodeling on x-ray. Good elbow and wrist-hand functions were noted. The child developed a single lung metastasis that was also removed. The question remains if the theoretical advantages in bone remodeling, shoulder stability, and bone growth are worth the extra time of surgery or the possible added donor and recipient site complications.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/17. Synchronous multifocal osteosarcoma with lymphatic spread in the lung: an autopsy case report.Synchronous multifocal/multicentric osteosarcoma (MOS) is a rare variant of osteosarcoma. We report here an autopsy case of a 15-year-old boy with MOS. Radiological examinations showed multiple sclerotic lesions in the left distal femur and in the ipsilateral proximal tibia without pulmonary metastasis at the first examination. Histological examination showed osteoblastic-type osteosarcoma. Despite high-dose chemotherapy the patient died of multiple bone and lung involvements 6 months after the initial diagnosis. autopsy examination revealed prominent invasion of the tumor cells into lymphatic vessels and pleural dissemination without the formation of bulky, nodular metastasis in the lungs. Metastases in pulmonary hilar lymph nodes were noted without metastasis in other organs. immunohistochemistry revealed that p53 protein was positive in most of the tumor cells. In summary, the present case was characterized by multiple bone involvement and prominent lymphatic spread of sarcoma cells in the lungs.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/17. Usefulness of a first transferred free flap vascular pedicle for secondary microvascular reconstruction in the head and neck.The authors found that a previously transferred free flap vascular pedicle, distal to the first microvascular anastomosis, can be used as a recipient vessel for an additional free flap transfer. Free flap transfers were performed by using the standard procedure in patients with head and neck cancer. The mean age of the patients was 62 years. Five patients were men and three were women. A second free flap was transferred for secondary primary head and neck cancer in two cases, facial deformity in two cases, osteomyelitis of the skull in two cases, recurrent cancer in one case, and exposure of a mandibular reconstruction plate in one case. The interval between the two operations was from 4 months to 12 years (median, 21 months). All secondary free flaps were performed successfully. In two cases, the external jugular vein proximal to the previously anastomosed site was used for venous drainage. In another case, additional venous anastomosis was performed for flap congestion. It became clear that a previously transferred free flap vascular pedicle could be used as a recipient vessel for microvascular anastomosis. This is an excellent procedure for additional free flap transfers.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
4/17. Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection.PURPOSE: Chondroblastic osteosarcoma requiring surgical intervention is associated with a high risk of pulmonary tumour embolism. Rapid intraoperative diagnosis with transesophageal echocardiography (TEE) allowed changing the management plan and treatment of a life-threatening pathology. CLINICAL FEATURES: A 32-yr-old female with right pelvic chondrosarcoma presented for right hemipelvectomy. Two hours into the operation during ligation of the iliac blood vessels the patient's hemodynamic condition deteriorated and was followed by cardiac arrest. TEE was performed immediately and revealed massive tumour embolism in the right and left pulmonary arteries. Large tumour emboli were removed from the right and left pulmonary arteries after median sternotomy under cardiopulmonary bypass and moderate hypothermia. The hemipelvectomy was completed on the next day after fluid and inotropic agent resuscitation. An inferior vena cava filter was placed below the renal veins. The patient was discharged from hospital ten days after the surgery. CONCLUSION: This case report illustrates the important role TEE can play in the early diagnosis and subsequent surgical treatment of noncardiac emergencies. Intraoperative TEE can have a significant impact on the decision making process in life threatening emergencies.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/17. osteosarcoma of the pelvis. A clinical and histopathological study of twenty-five patients.Twenty-five patients who had an osteosarcoma of the pelvis were treated at the University of florida between 1967 and 1990. Two of these patients had underlying Paget disease, and five had received previous radiation therapy to the pelvis. Common problems in this series of patients included delays and errors in establishment of the diagnosis, underestimation of the extent of the tumor on the radiographic staging studies, histopathological findings of local extension next to and into pelvic structures, widespread invasion into major pelvic veins, and microscopic foci of tumor in otherwise normal tissue. These problems led to difficulty in gaining local control of the tumor with any type of operative procedure. Of the eighteen patients who had a resection, only four had a contamination-free wide margin, and a local recurrence developed in thirteen. Only one patient, who had no evidence of disease eleven years after treatment, was alive at the time of writing. Because of the tendency for venous invasion, the radiographic staging studies should include a thorough evaluation of the blood vessels adjacent to the tumor.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/17. Intra-operative acute leg ischaemia after free fibula flap harvest for mandible reconstruction.Osteosarcomas of the cranial bones need a large surgical radical resection. The best option to reconstruct mandible defect after resection is the free fibula flap. In our patient an acute ischaemic leg occurred just after the free fibula flap harvest for mandible reconstruction. The abnormal distribution of the calf arteries leads to catastrophic consequences. The peroneal artery could be the main dominant artery of the leg in a small number of patients. We reported an extremely rare case of "peronea magna", described in less than 0.2% of the global population. A careful pre-operative workup of the calf vessels is required in all the patients who need free fibula flap harvest.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/17. Intra-arterial chemotherapy for limb preservation in patients with osteosarcoma: nursing implications.osteosarcoma is an aggressive tumor found in children and young adults, originating primarily in the legs or arms. The high-grade tumor grows in a circular, ball-like mass in the bone tissue. Before the 1970s and the advent of chemotherapy use in osteosarcoma, treatment consisted solely of amputation. More recently, a preoperative regimen of intra-arterial (IA) cisplatin and infusional doxorubicin with limb-sparing procedures has provided an effective treatment option and improved survival for many patients with osteosarcoma. IA chemotherapy is administered through a small, temporary, external catheter that rests in the arterial vessel that supplies the tumor. The primary advantage of IA chemotherapy administration is the delivery of a higher chemotherapy concentration directly to the tumor site, nursing management of patients with IA chemotherapy requires knowledge of treatment side effects and procedure-related assessments. Further implications for practice include instructing patients and families before and after the insertion of the IA line and giving discharge and long-term follow-up education. Oncology nurses are well positioned to assist children and young adult patients through difficulties with adjustment after treatment is completed and a response has been achieved, owing to advanced communication skills and knowledge of developmental stages and survivorship issues,- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/17. Monobloc resection of the upper extremity of the leg for bone tumor with distal vascular reconstruction.A patient with juxtacortical osteosarcoma of the upper extremity of the left tibia which encased the popliteal neurovascular bundle was treated by monobloc resection of the superior extremity of the tibia and the tibial nerve. The knee joint was replaced by a Guepar prosthetic knee. Arterial and venous continuity was reestablished by a double bypass using the contralateral greater saphenous vein. One year later the patient had good lower limb function and was free of local or general disease. This observation confirms that preservation of lower limb function is possible using reconstruction techniques of bone, nerves, and vessels in sarcoma of the musculoskeletal system.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/17. Rotationplasty for limb salvage in the treatment of malignant tumors at the knee. A follow-up study of seventy patients.Seventy patients who had a rotationplasty for treatment of a malignant tumor in the region of the knee (the femur or the tibia) between 1974 and 1987 were followed for two to thirteen years (mean duration of follow-up, four years). Forty-seven patients had a stage-IIB osteosarcoma; the remaining twenty-three patients had a malignant fibrous histiocytoma, a chondrosarcoma, a Ewing sarcoma, or a giant-cell tumor. The most severe postoperative complication was occlusion of the reanastomosed vessels (seven patients), leading to amputation proximal to the knee in three patients. Other complications were problems with wound-healing (eight patients), transient nerve palsy (five patients), irreversible nerve palsy (two patients), pseudarthrosis (four patients), and rotational malalignment (one patient). Late complications included eight fractures, two infections, two delayed unions, and one lymphatic fistula. More than half of the patients were free of complications related to the operative procedure. Forty-four of the patients who had a stage-IIB osteosarcoma could be followed, and their data were analyzed for survival statistics. These patients had a 58 percent rate of disease-free survival and a 70 per cent rate of over-all survival. One patient had a local recurrence five years after the operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/17. Cerebral necrosis following radiotherapy of extracranial neoplasms.We have examined 6 patients with delayed cerebral necrosis following irradiation of extracranial neoplasms. Four of the 6 patients received 1,760 rets (or less) tumor dose. The initial symptoms attributable to radiation necrosis appeared 4 to 31 months after irradiation and were those of a focal supratentorial mass. cerebral angiography delineated an avascular frontal or temporal lesion in all 6 patients; in 1 case a magnification study revealed narrowing, irregularity, and occlusion of small cortical vessels. Four of our 6 patients underwent craniotomy with partial or complete surgical extirpation of necrotic brain tissue. Two operated patients are alive and without disabling neurological symptoms 30 and 25 months, respectively, after the operation. The characteristic neuropathological features of delayed radiation necrosis of brain suggest that vascular injury rather than neuronal or glial damage is of primary pathogenetic significance.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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