Leiomyosarcoma of the popliteal artery: Case report and review of the literature

AbstractVascular leiomyosarcomas are rare tumors, and only 21 have been described as developing in the systemic arteries. We present a case, the sixth in the literature, of a leiomyosarcoma originating in the popliteal artery of a 67-year-old woman treated with en bloc excision of the neoplasia and the artery followed by a popliteal tibioperoneal trunk bypass. The patient then was underwent adjuvant radiotherapy and chemotherapy. After 31 months of follow-up, the patient has mild claudication but does not have either recurrence or metastasis. (J Vasc Surg 2003;37:206-9.

Intraoperative ultrasound and oncoplastic combined approach: an additional tool for the oncoplastic surgeon to obtain tumor-free margins in breast conservative surgery—a 2-year single-center prospective study

In case of breast postoncologic reconstructive surgery when an oncoplastic approach is adopted and volume replacement with glandular flap mobilization is performed, tumor-positive margins may create a significant problem. We present our experience with intraoperative ultrasound as an adjunctive tool to guide breast surgeons to improve margin-free management of neoplastic breast lesions in patients undergoing oncoplastic surgery

Oncoplastic conservative surgery for breast cancer: long-term outcomes of our first ten years experience

The main goal of oncoplastic breast surgery (OBS) is to optimize cosmetic outcomes and reduce patient morbidity, while still providing an oncologically-safe surgical outcome and extending the target population of conservative surgery. Although the growing number of reported experiences with oncoplastic surgery, few studies account for the long-term outcomes

Oncological safety of stromal vascular fraction enriched fat grafting in two-stage breast reconstruction after nipple sparing mastectomy: long-term results of a prospective study

OBJECTIVE: Autologous fat transfer (AFT) is commonly used to treat implant palpability and prevent fibrosis and thinning in mastectomy skin flaps. A major limit to this procedure is volume retention over time, leading to the introduction of fat enrichment with stromal vascular fraction (SVF+AFT). Oncological concerns have been raised over the injection of an increased concentration of progenitors cells (ASCs) in the SVF. The aim of the study is to evaluate the long-term cancer recurrence risk of SVF+AFT cases compared to AFT, in patients undergoing Nipple Sparing Mastectomy (NSM). PATIENTS AND METHODS: A prospective study was designed to compare three groups of patients undergoing NSM followed by SVF+AFT, AFT or none (control group), after a two-stage breast reconstruction. Patients were strictly followed-up for at least 5-years from the second stage reconstructive procedure. Loco-regional and systemic recurrence rate were evaluated over time as the primary outcome. Logistic regression was used to investigate which factors were associated with recurrence events and independent variables of interest were: surgical technique, age above 50 years old, lympho-vascular invasion, oncological stage, adjuvant or neoadjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy. RESULTS: 41 women were included in G1 (SVF+AFT), 64 in G2 (AFT), and 64 in G3 (control group). Loco-regional recurrence rate was 2.4% for G1, 4.7% for G2, and 1.6% for G3. Systemic recurrence was 7.3%, 3.1%, and 3.1%, respectively. Among the variables included, there were no significant risk factors influencing a recurrence event, either loco-regional or systemic. In particular, SVF+AFT (G1) did not increase the oncological recurrence. CONCLUSIONS: Our data suggest that both centrifuged and SVF-enhanced fat transfer have a similar safety level in comparison to patients who did not undergo fat grafting in breast reconstruction after NSM

Extended latissimus dorsi kite flap (eld-k flap). Revisiting an old place for a total autologous breast reconstruction in patients with medium to large breasts

Background: The latissimus dorsi (LD) flap represents one of the most reliable methods for autologous breast reconstruction. However, in many patients, the exclusive use of this technique may not guarantee the restoration of an adequate volume and projection. We report our experience with the extended latissimus dorsi kite flap (ELD-K flap), an alternative surgical approach to maximize the volume of the fleur-de-lis pattern LD flap, for total autologous breast reconstruction. Methods: Between 2016 and 2018, 23 patients were subjected to mastectomy and immediate autologous reconstruction with "extended latissimus dorsi kite flap" (ELD-K flap), technique that employs an extended version of the LD musculocutaneous flap, based on the skeletonized thoracodorsal pedicle and a trilobate skin incision with an inferiorly based vertical branch. The BREAST-Q questionnaire was administered preoperatively, and one year after surgery to evaluate the quality of life results of the patients. BREAST-Q latissimus dorsi module was also provided. Results: Average body mass index was 29.7 kg/m2 (range 25–40 kg/m2). Mild complications occurred in only six cases, and eight patients underwent treatment to improve the donor site scar outcome. Patients indicated high scores in quality of life measures with an increase in all BREAST domains from the preoperative to the postoperative period. A statistically significant increase (p < 0.05) was noted in: “overall satisfaction with breasts” (p < 0.05), “psychosocial well-being” (p < 0.05), “physical impact of the surgery” (p < 0.05). Within the LD module, participants reported a mean score of, respectively, 73.8 and 67.9 for “satisfaction with back” and “satisfaction with shoulder and back function” domains. Conclusions: The extended incision allows the recruitment of additional tissue to provide enough volume to complete the reconstruction without implants. The isolation of the vascular pedicle allows for extreme freedom and mobilization of the flap, ensuring adequate filling of the breast. ELD-K flap may expand the indications for a total autologous LD immediate breast reconstruction, representing an additional and reliable alternative in selected cohorts of patients. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

L'Octréotide dans le traitement des fistules chyleuses du cou. Présentation et revue de la littérature

Chylous leak; Octreotide; thyroid surger

Conservative treatment of chylous fistulas following neck surgery

Chylous fistula following an injury of the thoracic duct during neck surgery is an uncommon complication, its occurrence being higher with radical neck dissections. The treatment is controversial: usually conservative as first choice, surgical in case of persistence despite adequate medical treatment or in case of high output. The conservative management has a good success rate, but it is usually long and expensive, so several attempts to shorten it have been made. We present a case of postoperative chylous fistula in which octreotide administration was added to conventional conservative treatment, with resolution in four days. We also review the other reported cases in which the association of somatostatin to standard conservative treatment has been applied and we discuss the results. A 41 years old lady was referred to our Department for diagnostic resection of a left supraclavicular node swelling. FNAC was consistent with primary lymphatic disease. The patient underwent biopsy under general anaesthesia. Neoplastic tissue was involving as a single block both the supraclavicular and jugular lymphatic chains, and was partially resected. No intraoperative chyle leak was noted. The next morning the patient started oral feeding and 12 hours later 250 cc of white, milky fluid were collected. We started total parenteral nutrition (TPN), converted the drain from suction to gravity, adopted a semi-seated posture and applied pressure dressings. In order to reduce maximally the intestinal secretions we also started e.v. somatostatin (2 mg /day). At the end of first p.o. day the drain collected further 300 cc of chylous fluid. We then shifted to subcutaneous octreotide (0,1 mg x 3 /die). The output dropped to 60 cc (2nd p.o.), 30 cc (3rd p.o.). By 4th day the drain was nearly empty and in 6th day p.o. the patient was allowed to restart semiliquid oral feeding and, after a fatty meal test, the drain was removed and parenteral support and hormonal treatment were stopped. By day 8th the lady left the hospital. When the chylous fistula is recognised only postoperatively (usually after resuming oral feeding), first line treatment is usually conservative. It may lasts several weeks, is associated to high costs and is tedious to the patient. Nevertheless it has a good success rate, thus limiting the number of surgical re-exploration. SMS and its long acting analogues could act synergically with TPN in reducing gastrointestinal secretions, and allowing both the collapse of transected edge(s) of the duct and a correct repairing action of the naturally occurring inflammatory processes. According to our and other reported experiences, early association of octreotide to TPN seems to resolve chylous leaks in a few days, thus sensibly reducing in-hospital stay and related costs