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Soft Tissue Sarcomas of the Foot and Ankle: Recommendations Based on a Retrospective Series Treated by a Single Surgeon
Vol. 223, No. 4S2, October 2016
23.8 (range: 13-30) and ECOG/KPS scores ranged from 1-5/0-100 (average: 1.57/76.4). Despite 2 low pain scores, all other patients were adequately palliated and could use their extremities for activities of daily living. The sole complication was a non-union of a pathological fracture due to postoperative radiation, which caused hardware failure (plate¼1). CONCLUSIONS: Patients with impending or actual pathological fractures of the proximal humerus from metastatic cancers can be safely treated and adequately palliated with either IMN or plate fixation. Most patients are pain-free and have good to excellent functional outcomes within a short time frame from surgery. There is a low rate of complications. Method of fixation may be chosen based on availability of bone stock for proximal fixation with screws and ability to augment fixation with PMMA. Retrospective Analysis of 21 Patients with Schwannomas: MRI Characteristics, Pain and Outcomes after Excision Jette Hooper, Ivan Golub, Alexander P Decilveo, Ian T O’Connor, Jacob Topfer, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ INTRODUCTION: Schwannomas are benign nerve sheath tumors that can arise in all ages. The purpose of this study is to describe the surgical procedure for removing schwannomas and report the clinical and radiological presentations as well as outcomes in our group of 21 patients. METHODS: From 2007-2015 we retrospectively reviewed 20 patients’ charts who underwent excision of a schwannoma. The operative approach involved removing the schwannoma, preserving its nearby nerve fascicles, and leaving the epineurium open. Clinical presentation, location of tumor, nerve of origin, MRI characteristics, postoperative outcomes, and complications were recorded. All patients were followed up for a minimum of 3 months. RESULTS: Mean follow-up ranged from 3 to 91 months (average: 29 months). There were 12 patients with a Tinel’s signal and 2 patients with a classic target sign. Split fat signs were observed in all deep tumors arising from major peripheral nerves. All patients were pain-free at first follow-up within 2 weeks from surgery and regained normal function in their respective extremities. There were no instances of local recurrence. There was one case of a postoperative posterior interosseous nerve palsy that resolved. There were no other complications. CONCLUSIONS: Preoperative MRI can be highly suggestive of a schwannoma if there is a characteristic split fat or target sign and if the nerve of origin can be visualized entering and exiting the mass. Schwannomas can be safely removed via surgical excision after isolating the nerve and its fascicles. Pain is routinely eradicated and function restored with few complications.
Scientific Poster Presentations: 2016 Clinical Congress
e151
Rotational Muscle Flaps for High-Grade Soft Tissue Sarcomas around the Knee Provide Great Function Joel R Peterson, Ivan Golub, Alexander P Decilveo, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ, Rutgers Robert Wood Johnson Medical School, New Brunswick NJ INTRODUCTION: Our study aims to assess the functional outcomes related to resection of musculoskeletal tumors arising around the knee and coverage using rotational muscle flaps, especially the gastrocnemius muscle flap. METHODS: We retrospectively analyzed the charts of 5 patients from 2008 to 2015 who underwent surgery for soft tissue sarcomas arising around the knee and were treated with rotational muscle flaps. At final follow-up, all patients were evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system. Local tumor control, survival, and complications were also recorded. RESULTS: Average length of follow-up was 24.8 months (range: 5-77 months). MSTS score at final follow-up was 30 for all patients. All patients are currently alive, disease free, pain free, have excellent range of motion (at least 0 to 120 degrees) of the knee, and have unlimited ambulatory capacity without an assist device. All patellas tracked normally. All flaps and skin grafts healed without complications. There were no infections and no instances of chronic edema. There were no local recurrences, complications, or amputations. CONCLUSIONS: Our small cohort of patients who underwent rotational muscle flaps and transfers after resections around the knee have excellent functional outcomes and virtually normal active range of motion. We highly recommend local muscle rotational flaps to protect the bone and joint, augment function, and reduce complication rates when resection results in bare bone, exposed knee joint, or exposed neurovascular structures, especially when performed in conjunction with radiation exposure. The medial and lateral gastrocnemius muscles are reliable sources for these local muscle flaps.
Soft Tissue Sarcomas of the Foot and Ankle: Recommendations Based on a Retrospective Series Treated by a Single Surgeon Drew E Murray, Alexander P Decilveo, Ivan Golub, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ INTRODUCTION: Soft tissue sarcomas arising in the foot and ankle are often misdiagnosed, resulting in an excision without adequate preoperative staging or surgical margins. The goal of this study is to review our case series of soft tissue sarcomas of the foot and ankle with attention directed at unplanned excisions of sarcomas.
e152
Scientific Poster Presentations: 2016 Clinical Congress
METHODS: We retrospectively analyzed charts of 10 patients with sarcomas of the foot and ankle treated at our institution. All soft tissue sarcomas were excised with the widest margin possible without any major bone or neurovascular resections to allow preservation of the foot. All patients were followed for a minimum of 3 months to assess pain, function, and complications. RESULTS: Patients were followed for an average of 15.5 months (range: 4-34 months). Six sarcomas had preoperative MRIs without contrast that were read as benign or cystic masses. Two sarcomas had preoperative MRIs with contrast that were also misread. Despite having previous unplanned surgeries, none of these
J Am Coll Surg
sarcomas recurred after re-resection with a wider margin at a mean follow-up of 15.5 months (range: 4-34 months). Eight patients with sarcomas are alive without evidence of disease. Minor complications included lymph edema (n¼1), stress fracture (n¼1), and wound infection (n¼1) that resolved. CONCLUSIONS: Preoperative MRI with contrast is recommended before resecting any soft tissue masses of the foot and ankle. In the event of an unplanned excision of a soft tissue sarcoma, the patient should be referred to an orthopedic oncologist for definitive surgery in order to optimize oncological and functional results.
23.8 (range: 13-30) and ECOG/KPS scores ranged from 1-5/0-100 (average: 1.57/76.4). Despite 2 low pain scores, all other patients were adequately palliated and could use their extremities for activities of daily living. The sole complication was a non-union of a pathological fracture due to postoperative radiation, which caused hardware failure (plate¼1). CONCLUSIONS: Patients with impending or actual pathological fractures of the proximal humerus from metastatic cancers can be safely treated and adequately palliated with either IMN or plate fixation. Most patients are pain-free and have good to excellent functional outcomes within a short time frame from surgery. There is a low rate of complications. Method of fixation may be chosen based on availability of bone stock for proximal fixation with screws and ability to augment fixation with PMMA. Retrospective Analysis of 21 Patients with Schwannomas: MRI Characteristics, Pain and Outcomes after Excision Jette Hooper, Ivan Golub, Alexander P Decilveo, Ian T O’Connor, Jacob Topfer, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ INTRODUCTION: Schwannomas are benign nerve sheath tumors that can arise in all ages. The purpose of this study is to describe the surgical procedure for removing schwannomas and report the clinical and radiological presentations as well as outcomes in our group of 21 patients. METHODS: From 2007-2015 we retrospectively reviewed 20 patients’ charts who underwent excision of a schwannoma. The operative approach involved removing the schwannoma, preserving its nearby nerve fascicles, and leaving the epineurium open. Clinical presentation, location of tumor, nerve of origin, MRI characteristics, postoperative outcomes, and complications were recorded. All patients were followed up for a minimum of 3 months. RESULTS: Mean follow-up ranged from 3 to 91 months (average: 29 months). There were 12 patients with a Tinel’s signal and 2 patients with a classic target sign. Split fat signs were observed in all deep tumors arising from major peripheral nerves. All patients were pain-free at first follow-up within 2 weeks from surgery and regained normal function in their respective extremities. There were no instances of local recurrence. There was one case of a postoperative posterior interosseous nerve palsy that resolved. There were no other complications. CONCLUSIONS: Preoperative MRI can be highly suggestive of a schwannoma if there is a characteristic split fat or target sign and if the nerve of origin can be visualized entering and exiting the mass. Schwannomas can be safely removed via surgical excision after isolating the nerve and its fascicles. Pain is routinely eradicated and function restored with few complications.
Scientific Poster Presentations: 2016 Clinical Congress
e151
Rotational Muscle Flaps for High-Grade Soft Tissue Sarcomas around the Knee Provide Great Function Joel R Peterson, Ivan Golub, Alexander P Decilveo, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ, Rutgers Robert Wood Johnson Medical School, New Brunswick NJ INTRODUCTION: Our study aims to assess the functional outcomes related to resection of musculoskeletal tumors arising around the knee and coverage using rotational muscle flaps, especially the gastrocnemius muscle flap. METHODS: We retrospectively analyzed the charts of 5 patients from 2008 to 2015 who underwent surgery for soft tissue sarcomas arising around the knee and were treated with rotational muscle flaps. At final follow-up, all patients were evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system. Local tumor control, survival, and complications were also recorded. RESULTS: Average length of follow-up was 24.8 months (range: 5-77 months). MSTS score at final follow-up was 30 for all patients. All patients are currently alive, disease free, pain free, have excellent range of motion (at least 0 to 120 degrees) of the knee, and have unlimited ambulatory capacity without an assist device. All patellas tracked normally. All flaps and skin grafts healed without complications. There were no infections and no instances of chronic edema. There were no local recurrences, complications, or amputations. CONCLUSIONS: Our small cohort of patients who underwent rotational muscle flaps and transfers after resections around the knee have excellent functional outcomes and virtually normal active range of motion. We highly recommend local muscle rotational flaps to protect the bone and joint, augment function, and reduce complication rates when resection results in bare bone, exposed knee joint, or exposed neurovascular structures, especially when performed in conjunction with radiation exposure. The medial and lateral gastrocnemius muscles are reliable sources for these local muscle flaps.
Soft Tissue Sarcomas of the Foot and Ankle: Recommendations Based on a Retrospective Series Treated by a Single Surgeon Drew E Murray, Alexander P Decilveo, Ivan Golub, James C Wittig, MD Hackensack University Medical Center, Hackensack, NJ INTRODUCTION: Soft tissue sarcomas arising in the foot and ankle are often misdiagnosed, resulting in an excision without adequate preoperative staging or surgical margins. The goal of this study is to review our case series of soft tissue sarcomas of the foot and ankle with attention directed at unplanned excisions of sarcomas.
e152
Scientific Poster Presentations: 2016 Clinical Congress
METHODS: We retrospectively analyzed charts of 10 patients with sarcomas of the foot and ankle treated at our institution. All soft tissue sarcomas were excised with the widest margin possible without any major bone or neurovascular resections to allow preservation of the foot. All patients were followed for a minimum of 3 months to assess pain, function, and complications. RESULTS: Patients were followed for an average of 15.5 months (range: 4-34 months). Six sarcomas had preoperative MRIs without contrast that were read as benign or cystic masses. Two sarcomas had preoperative MRIs with contrast that were also misread. Despite having previous unplanned surgeries, none of these
J Am Coll Surg
sarcomas recurred after re-resection with a wider margin at a mean follow-up of 15.5 months (range: 4-34 months). Eight patients with sarcomas are alive without evidence of disease. Minor complications included lymph edema (n¼1), stress fracture (n¼1), and wound infection (n¼1) that resolved. CONCLUSIONS: Preoperative MRI with contrast is recommended before resecting any soft tissue masses of the foot and ankle. In the event of an unplanned excision of a soft tissue sarcoma, the patient should be referred to an orthopedic oncologist for definitive surgery in order to optimize oncological and functional results.