Reconstruction after Soft Tissue Sarcoma Resection in the Setting of Brachytherapy

A 10-Year Experience

Hung Yi Lee, Peter G. Cordeiro, Babak J. Mehrara, Samuel Singer, Khalid M. Alektiar, Qun Ying Hu, Joseph J. Disa, Donald Mackay

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Management of recurrent soft tissue sarcomas often involves surgical resection and adjuvant brachytherapy. This study reviews our experience in the management of these patients and proposes a logical approach toward reconstruction. All patients who underwent soft tissue sarcoma resection, adjuvant brachytherapy, and soft tissue flap reconstruction (pedicled or free) during the 10-year period from 1991 to 2000 were included in this study. There were 17 patients (14 male, 3 female) with a mean age of 51 years (range, 16-80 years). Soft tissue sarcomas were distributed in the lower extremity (n = 9), upper extremity (n = 5), and trunk (n = 3). Reconstruction was accomplished by regional transposition flaps (n = 10) and free tissue transfer (n = 7). The average defect size was 143 cm 2. Patients received 5 to 12 (mean, 8) brachytherapy catheters. The brachytherapy dose delivered ranged from 1600 to 4500 cGy (mean, 3773 cGy). Brachytherapy catheters were loaded with radioactive sources between 5 and 7 days postoperatively. All flaps in this series survived. One patient required return to the operating room for revision of a venous thrombosis with flap salvage. Closed suction drainage tubes were left in place until after the brachytherapy catheters were removed to avoid dislodging the catheters. Two patients developed postradiation partial-thickness skin necrosis with delayed secondary wound healing. This study demonstrates that soft tissue reconstruction in the setting of sarcoma resection and brachytherapy catheter placement is safe and efficacious. Postoperative wound healing complications can be minimized through coordination among the ablative surgeon, reconstructive surgeon, and radiation oncologist. Specifically, placement of microvascular anastomoses well away from the radiation target area is indicated whenever possible. Finally, removal of closed suction drainage tubes should be deferred until after the brachytherapy catheters are removed to minimize complications resulting from catheter dislodgement.

Original languageEnglish (US)
Pages (from-to)486-492
Number of pages7
JournalAnnals of Plastic Surgery
Volume52
Issue number5
DOIs
StatePublished - May 1 2004

Fingerprint

antineoplaston A10
Brachytherapy
Sarcoma
Catheters
Suction
Wound Healing
Surgical Flaps
Free Tissue Flaps
Operating Rooms
Upper Extremity
Venous Thrombosis
Lower Extremity
Necrosis
Radiation
Skin

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Lee, Hung Yi ; Cordeiro, Peter G. ; Mehrara, Babak J. ; Singer, Samuel ; Alektiar, Khalid M. ; Hu, Qun Ying ; Disa, Joseph J. ; Mackay, Donald. / Reconstruction after Soft Tissue Sarcoma Resection in the Setting of Brachytherapy : A 10-Year Experience. In: Annals of Plastic Surgery. 2004 ; Vol. 52, No. 5. pp. 486-492.
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title = "Reconstruction after Soft Tissue Sarcoma Resection in the Setting of Brachytherapy: A 10-Year Experience",
abstract = "Management of recurrent soft tissue sarcomas often involves surgical resection and adjuvant brachytherapy. This study reviews our experience in the management of these patients and proposes a logical approach toward reconstruction. All patients who underwent soft tissue sarcoma resection, adjuvant brachytherapy, and soft tissue flap reconstruction (pedicled or free) during the 10-year period from 1991 to 2000 were included in this study. There were 17 patients (14 male, 3 female) with a mean age of 51 years (range, 16-80 years). Soft tissue sarcomas were distributed in the lower extremity (n = 9), upper extremity (n = 5), and trunk (n = 3). Reconstruction was accomplished by regional transposition flaps (n = 10) and free tissue transfer (n = 7). The average defect size was 143 cm 2. Patients received 5 to 12 (mean, 8) brachytherapy catheters. The brachytherapy dose delivered ranged from 1600 to 4500 cGy (mean, 3773 cGy). Brachytherapy catheters were loaded with radioactive sources between 5 and 7 days postoperatively. All flaps in this series survived. One patient required return to the operating room for revision of a venous thrombosis with flap salvage. Closed suction drainage tubes were left in place until after the brachytherapy catheters were removed to avoid dislodging the catheters. Two patients developed postradiation partial-thickness skin necrosis with delayed secondary wound healing. This study demonstrates that soft tissue reconstruction in the setting of sarcoma resection and brachytherapy catheter placement is safe and efficacious. Postoperative wound healing complications can be minimized through coordination among the ablative surgeon, reconstructive surgeon, and radiation oncologist. Specifically, placement of microvascular anastomoses well away from the radiation target area is indicated whenever possible. Finally, removal of closed suction drainage tubes should be deferred until after the brachytherapy catheters are removed to minimize complications resulting from catheter dislodgement.",
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Reconstruction after Soft Tissue Sarcoma Resection in the Setting of Brachytherapy : A 10-Year Experience. / Lee, Hung Yi; Cordeiro, Peter G.; Mehrara, Babak J.; Singer, Samuel; Alektiar, Khalid M.; Hu, Qun Ying; Disa, Joseph J.; Mackay, Donald.

In: Annals of Plastic Surgery, Vol. 52, No. 5, 01.05.2004, p. 486-492.

Research output: Contribution to journalReview article

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T2 - A 10-Year Experience

AU - Lee, Hung Yi

AU - Cordeiro, Peter G.

AU - Mehrara, Babak J.

AU - Singer, Samuel

AU - Alektiar, Khalid M.

AU - Hu, Qun Ying

AU - Disa, Joseph J.

AU - Mackay, Donald

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AB - Management of recurrent soft tissue sarcomas often involves surgical resection and adjuvant brachytherapy. This study reviews our experience in the management of these patients and proposes a logical approach toward reconstruction. All patients who underwent soft tissue sarcoma resection, adjuvant brachytherapy, and soft tissue flap reconstruction (pedicled or free) during the 10-year period from 1991 to 2000 were included in this study. There were 17 patients (14 male, 3 female) with a mean age of 51 years (range, 16-80 years). Soft tissue sarcomas were distributed in the lower extremity (n = 9), upper extremity (n = 5), and trunk (n = 3). Reconstruction was accomplished by regional transposition flaps (n = 10) and free tissue transfer (n = 7). The average defect size was 143 cm 2. Patients received 5 to 12 (mean, 8) brachytherapy catheters. The brachytherapy dose delivered ranged from 1600 to 4500 cGy (mean, 3773 cGy). Brachytherapy catheters were loaded with radioactive sources between 5 and 7 days postoperatively. All flaps in this series survived. One patient required return to the operating room for revision of a venous thrombosis with flap salvage. Closed suction drainage tubes were left in place until after the brachytherapy catheters were removed to avoid dislodging the catheters. Two patients developed postradiation partial-thickness skin necrosis with delayed secondary wound healing. This study demonstrates that soft tissue reconstruction in the setting of sarcoma resection and brachytherapy catheter placement is safe and efficacious. Postoperative wound healing complications can be minimized through coordination among the ablative surgeon, reconstructive surgeon, and radiation oncologist. Specifically, placement of microvascular anastomoses well away from the radiation target area is indicated whenever possible. Finally, removal of closed suction drainage tubes should be deferred until after the brachytherapy catheters are removed to minimize complications resulting from catheter dislodgement.

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