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Salvage surgery and microsurgical reconstruction for recurrence of skull base osteosarcoma after carbon ion radiotherapy.

Kohyama K, Yamada K, Sugiura H, Hyodo I, Ozawa T, Hasegawa Y, Kato H, Kamei Y - Nagoya J Med Sci (2015)

Bottom Line: As the patient developed no postoperative wound complications, she was able to initiate adjuvant chemotherapy early.Although the affected field may be limited, its high potency may severely damage adjacent normal tissue and lead to serious postoperative complications.Despite these concerns, satisfactory results were achieved in this case.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Gifu University Hospital, Gifu, Japan ; Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

ABSTRACT
Carbon ion radiotherapy has recently emerged as an alternative choice of treatment for malignant tumors of the head and neck. However, it is still in the infant stages and its influence on subsequent salvage surgery remains unclear. Here we report the case of a 43-year-old woman who underwent salvage surgery for left frontal bone osteosarcoma recurrence following carbon ion radiotherapy. Tumor resection was performed with a wide margin including the tissue considered to have been damaged by carbon ion radiotherapy. The dural defect was reconstructed using a fascia lata graft and pedicled galeal pericranial flap. The soft tissue defect was reconstructed using an anterolateral thigh flap anastomosed to the ipsilateral neck interposed by the radial forearm flap. As the patient developed no postoperative wound complications, she was able to initiate adjuvant chemotherapy early. Carbon ion radiotherapy is useful for its focused distribution and strong biological effects. Although the affected field may be limited, its high potency may severely damage adjacent normal tissue and lead to serious postoperative complications. Despite these concerns, satisfactory results were achieved in this case.

No MeSH data available.


Related in: MedlinePlus

(A) Wide resection with a 2-cm margin from the edge of swelling was performed. (B) The left eye ball, dura mater, left frontal skull base, and the region of reddish tissue damaged by carbon ion radiotherapy were resected. (C) The dural defect was reconstructed using a free non-vascularized fascia lata graft (white arrow). (D) The soft tissue defect was reconstructed using a radial forearm flap (black arrow) and an anterolateral thigh flap (white arrow).
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fig3: (A) Wide resection with a 2-cm margin from the edge of swelling was performed. (B) The left eye ball, dura mater, left frontal skull base, and the region of reddish tissue damaged by carbon ion radiotherapy were resected. (C) The dural defect was reconstructed using a free non-vascularized fascia lata graft (white arrow). (D) The soft tissue defect was reconstructed using a radial forearm flap (black arrow) and an anterolateral thigh flap (white arrow).

Mentions: The patient underwent wide resection of the mass and normal tissue considered to have been damaged by carbon ion radiotherapy. Wide resection was performed with a 2-cm margin from the edge of swelling (Figure 3A), and included the left eyeball, part of the frontal bone, dura mater, the left frontal skull base, and the region of reddish tissue damaged by carbon ion radiotherapy (Figure 3B). The dural defect was reconstructed with a free non-vascularized fascia lata graft (Figure 3C). A galeal pericranial flap pedicled on the ipsilateral superficial temporal artery was applied over the fascia lata. Although reconstruction of the defect required free tissue transfer, the distance between the defect and recipient vessels was too long. To overcome this problem, we harvested a radial forearm (RF) flap and anterolateral thigh (ALT) flap. The RF flap was anastomosed end-to-end to the recipient vessels in the ipsilateral neck (superior thyroid artery, external jugular vein, and facial vein), and the ALT flap was anastomosed end-to-end to the distal end of the RF flap (Figure 3D, 4).


Salvage surgery and microsurgical reconstruction for recurrence of skull base osteosarcoma after carbon ion radiotherapy.

Kohyama K, Yamada K, Sugiura H, Hyodo I, Ozawa T, Hasegawa Y, Kato H, Kamei Y - Nagoya J Med Sci (2015)

(A) Wide resection with a 2-cm margin from the edge of swelling was performed. (B) The left eye ball, dura mater, left frontal skull base, and the region of reddish tissue damaged by carbon ion radiotherapy were resected. (C) The dural defect was reconstructed using a free non-vascularized fascia lata graft (white arrow). (D) The soft tissue defect was reconstructed using a radial forearm flap (black arrow) and an anterolateral thigh flap (white arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664599&req=5

fig3: (A) Wide resection with a 2-cm margin from the edge of swelling was performed. (B) The left eye ball, dura mater, left frontal skull base, and the region of reddish tissue damaged by carbon ion radiotherapy were resected. (C) The dural defect was reconstructed using a free non-vascularized fascia lata graft (white arrow). (D) The soft tissue defect was reconstructed using a radial forearm flap (black arrow) and an anterolateral thigh flap (white arrow).
Mentions: The patient underwent wide resection of the mass and normal tissue considered to have been damaged by carbon ion radiotherapy. Wide resection was performed with a 2-cm margin from the edge of swelling (Figure 3A), and included the left eyeball, part of the frontal bone, dura mater, the left frontal skull base, and the region of reddish tissue damaged by carbon ion radiotherapy (Figure 3B). The dural defect was reconstructed with a free non-vascularized fascia lata graft (Figure 3C). A galeal pericranial flap pedicled on the ipsilateral superficial temporal artery was applied over the fascia lata. Although reconstruction of the defect required free tissue transfer, the distance between the defect and recipient vessels was too long. To overcome this problem, we harvested a radial forearm (RF) flap and anterolateral thigh (ALT) flap. The RF flap was anastomosed end-to-end to the recipient vessels in the ipsilateral neck (superior thyroid artery, external jugular vein, and facial vein), and the ALT flap was anastomosed end-to-end to the distal end of the RF flap (Figure 3D, 4).

Bottom Line: As the patient developed no postoperative wound complications, she was able to initiate adjuvant chemotherapy early.Although the affected field may be limited, its high potency may severely damage adjacent normal tissue and lead to serious postoperative complications.Despite these concerns, satisfactory results were achieved in this case.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Gifu University Hospital, Gifu, Japan ; Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

ABSTRACT
Carbon ion radiotherapy has recently emerged as an alternative choice of treatment for malignant tumors of the head and neck. However, it is still in the infant stages and its influence on subsequent salvage surgery remains unclear. Here we report the case of a 43-year-old woman who underwent salvage surgery for left frontal bone osteosarcoma recurrence following carbon ion radiotherapy. Tumor resection was performed with a wide margin including the tissue considered to have been damaged by carbon ion radiotherapy. The dural defect was reconstructed using a fascia lata graft and pedicled galeal pericranial flap. The soft tissue defect was reconstructed using an anterolateral thigh flap anastomosed to the ipsilateral neck interposed by the radial forearm flap. As the patient developed no postoperative wound complications, she was able to initiate adjuvant chemotherapy early. Carbon ion radiotherapy is useful for its focused distribution and strong biological effects. Although the affected field may be limited, its high potency may severely damage adjacent normal tissue and lead to serious postoperative complications. Despite these concerns, satisfactory results were achieved in this case.

No MeSH data available.


Related in: MedlinePlus