J. Matějovská1, P. Christodoulou1, V. Šorelová1, M. Fridrichová2, Z. Matějovský3
1 Department of Plastic Surgery, University Hospital Bulovka, Institute for Postgraduate Studies, 1st Medical Faculty, Charles University, Prague
2 Department of Clinical Oncology, University Hospital Bulovka, Institute for Postgraduate Studies, 1st Medical Faculty, Charles University, Prague 3 Department of Orthopedics, University Hospital Bulovka, Institute for Postgraduate Studies, 1st Medical Faculty, Charles University, Prague
Summary
Introduction: Artificial skin replacements were developed to cover defects in general surgery or after burns. Their main indication in oncologic surgery is secondary resection of appropriate margins in skin tumors after incomplete primary excision. This is contraindicated in sarcomas where only wide excision is indicated. The aim of the study is to show rare possible indications for temporary skin closure (TSC) in extremity soft tissue sarcomas (STS). Materials and methods: Out of 594 patients with extremity STS treated surgically at the Department of Orthopedics, University Hospital Bulovka, Prague, since 2014, we evaluated those with TSC concerning their indications. Results: TSC (Aquagel twice, Parasorb four times, and COM 30 five times) was used in 11 patients. Six cases were on the foot, three on the femur and two on the lower legs. Seven cases were high-grade sarcomas, two cases were synovial sarcomas, one case was low-grade myxofibrosarcoma and one case was low-grade malignant peripheral nerve sheath tumor. We covered tendons five times, bones four times and vessels once. Ten of the 11 cases were recurrent tumors with extensive reconstructions, an increased risk of infection or unclear final histology. Two-stage surgeries seem good indications to decrease the adverse effects of prolonged surgery on flap perfusion or patient’s status. Discussion: Not only the anesthesiologic, but also oncologic factors, potentiating the adverse effects of prolonged surgery on the patient and flaps, are discussed. The pros and cons of individual indications and their alternatives are compared. Conclusion: The indications for TSC in extremity STS are rare, but exist. TSC can be a good solution, enabling a safe two-stage reconstruction at a specialized plastic surgery unit, after an initial wide excision at a department of oncologic surgery. This can be a safer method concerning the perfusion of flaps and general status of an oncologic patient.
Key words
temporary skin closure – soft tissue sarcoma – two-stage surgery – microvascular flaps – local flaps – defects after tumor surgery – synthetic skin replacement – secondary wound closure – artificial skin replacement