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MR imaging appearances of soft tissue flaps following reconstructive surgery of the lower extremity.

Magerkurth O, Girish G, Jacobson JA, Kim SM, Brigido MK, Dong Q, Jamadar DA - Korean J Radiol (2015)

Bottom Line: Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect.The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare.Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Hospital Baden, Baden 5405, Switzerland.

ABSTRACT
MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

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59-year-old woman with recurrence of high grade myxofibroma after initial wound closure by medial gastrocnemius flap and re-excision closure with free latissimus dorsi flap.A. Coronal T1-weighted MR image shows lobular and heterogeneous appearance of recurrent tumor (T), which extends proximally and medially to gastrocnemius flap (F). B. Coronal T1-weighted MR image after re-excision and coverage of defect with free latissimus dorsi flap (F), which extends from medial thigh. C. Corresponding axial T1-weighted MR image after re-excision and coverage of popliteal region with free latissimus dorsi flap (F). C = medial femoral condyle, Tib = left tibia
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Figure 11: 59-year-old woman with recurrence of high grade myxofibroma after initial wound closure by medial gastrocnemius flap and re-excision closure with free latissimus dorsi flap.A. Coronal T1-weighted MR image shows lobular and heterogeneous appearance of recurrent tumor (T), which extends proximally and medially to gastrocnemius flap (F). B. Coronal T1-weighted MR image after re-excision and coverage of defect with free latissimus dorsi flap (F), which extends from medial thigh. C. Corresponding axial T1-weighted MR image after re-excision and coverage of popliteal region with free latissimus dorsi flap (F). C = medial femoral condyle, Tib = left tibia

Mentions: Care should be taken to differentiate radiation-induced changes from infection, which also demonstrates edema and contrast enhancement involving the flaps but no focal mass effect (Fig. 10). The latter tend to be more diffuse, while radiation-induced changes follow the size and shape of the radiation portal. Additionally, correlation with clinical data is essential. Sometimes, a needle-guided aspiration may be necessary to differentiate the two. In tumor patients, close scrutiny should be provided regarding tumor recurrence, depicted as new, mass-like, nodular, expanding lesions that demonstrate contrast enhancement, especially in the first 6-12 months after resection (Fig. 11) (7, 8). The comparison of the imaging pattern of the initial tumor and the recurrence can be very helpful to differentiate these from complex fluid collection. In ambiguous cases, dynamic imaging with a rapid injection of contrast may be helpful because recurrent tumors tend to enhance more rapidly than inflammation, or fibrosis (20). If the finding still remains suspicious, a needle-guided aspiration may be necessary to differentiate.


MR imaging appearances of soft tissue flaps following reconstructive surgery of the lower extremity.

Magerkurth O, Girish G, Jacobson JA, Kim SM, Brigido MK, Dong Q, Jamadar DA - Korean J Radiol (2015)

59-year-old woman with recurrence of high grade myxofibroma after initial wound closure by medial gastrocnemius flap and re-excision closure with free latissimus dorsi flap.A. Coronal T1-weighted MR image shows lobular and heterogeneous appearance of recurrent tumor (T), which extends proximally and medially to gastrocnemius flap (F). B. Coronal T1-weighted MR image after re-excision and coverage of defect with free latissimus dorsi flap (F), which extends from medial thigh. C. Corresponding axial T1-weighted MR image after re-excision and coverage of popliteal region with free latissimus dorsi flap (F). C = medial femoral condyle, Tib = left tibia
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296265&req=5

Figure 11: 59-year-old woman with recurrence of high grade myxofibroma after initial wound closure by medial gastrocnemius flap and re-excision closure with free latissimus dorsi flap.A. Coronal T1-weighted MR image shows lobular and heterogeneous appearance of recurrent tumor (T), which extends proximally and medially to gastrocnemius flap (F). B. Coronal T1-weighted MR image after re-excision and coverage of defect with free latissimus dorsi flap (F), which extends from medial thigh. C. Corresponding axial T1-weighted MR image after re-excision and coverage of popliteal region with free latissimus dorsi flap (F). C = medial femoral condyle, Tib = left tibia
Mentions: Care should be taken to differentiate radiation-induced changes from infection, which also demonstrates edema and contrast enhancement involving the flaps but no focal mass effect (Fig. 10). The latter tend to be more diffuse, while radiation-induced changes follow the size and shape of the radiation portal. Additionally, correlation with clinical data is essential. Sometimes, a needle-guided aspiration may be necessary to differentiate the two. In tumor patients, close scrutiny should be provided regarding tumor recurrence, depicted as new, mass-like, nodular, expanding lesions that demonstrate contrast enhancement, especially in the first 6-12 months after resection (Fig. 11) (7, 8). The comparison of the imaging pattern of the initial tumor and the recurrence can be very helpful to differentiate these from complex fluid collection. In ambiguous cases, dynamic imaging with a rapid injection of contrast may be helpful because recurrent tumors tend to enhance more rapidly than inflammation, or fibrosis (20). If the finding still remains suspicious, a needle-guided aspiration may be necessary to differentiate.

Bottom Line: Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect.The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare.Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Hospital Baden, Baden 5405, Switzerland.

ABSTRACT
MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

Show MeSH
Related in: MedlinePlus