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2015 ; 5
(ä): 268
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English Wikipedia
Plastic Surgery in the Multimodal Treatment Concept of Soft Tissue Sarcoma:
Influence of Radiation, Chemotherapy, and Isolated Limb Perfusion on Plastic
Surgery Techniques
#MMPMID26649280
Kapalschinski N
; Goertz O
; Harati K
; Kueckelhaus M
; Kolbenschlag J
; Lehnhardt M
; Hirsch T
Front Oncol
2015[]; 5
(ä): 268
PMID26649280
show ga
Surgical intervention is the mainstay treatment for soft tissue sarcomas (STSs).
The significance of adjuvant and neoadjuvant therapies, such as chemotherapy,
radiation, and isolated limb perfusion, remains under controversial discussion.
The goal of this review is to discuss the effects of the aforementioned treatment
modalities and their timing of application in plastic surgery techniques.
Furthermore, options of reconstruction in cases of complications caused by
adjuvant and neoadjuvant therapies are discussed. When compared with adjuvant
radiation, neoadjuvant treatment can reduce negative side effects such as
fibrosis and edema because radioderma can be removed during the subsequent
surgical procedure. Furthermore, there have not been any reports of negative
effects of neoadjuvant radiation on microsurgical procedures. However, the dose
of neoadjuvant radiation correlates with increased risks of impaired wound
healing postoperatively. Thus, a patient-specific approach to decide whether
radiation should be performed adjuvant or neoadjuvant is necessary. Preoperative
irradiation should be considered in cases where functional structures are exposed
after tumor resection, in order to ensure the best possible functionality.
Adjuvant radiation should be considered in all other cases because of its known
superior wound healing. As for chemotherapy, no negative influence of its use
adjuvant or neoadjuvant to reconstructive procedures, such as local or free
flaps, has been reported. Lastly, small sample size studies have not shown
increased risks of microsurgical failure or wound complications after isolated
limb perfusion. The findings of this review suggest that the chronological order
of the discussed therapeutic approaches is not a decisive factor in the surgical
outcome of reconstructive procedures for STS.