ASO Author Reflection : Demographic Conditions are the Major Determinants for Functional Outcome and Quality of Life in Lower Extremity Soft Tissue Sarcoma Patients

Non peer reviewe

Microvascular reconstruction in extremity soft tissue sarcoma surgery

Soft tissue sarcomas (STS) are rare tumors of soft tissue occurring most frequently in the extremities. Modern treatment of extremity STS is based on limb-sparing surgery combined with radiotherapy. To prevent local recurrence, a healthy tissue margin of 2.5 cm around the resected tumor is required. This results in large defects of soft tissue and bone, necessitating the use of reconstructive surgery to achieve wound closure. When local or pedicled soft tissue flaps are unavailable, reconstruction with free flaps is used. Free flaps are elevated at a distant site, and have their blood flow restored at the recipient site through microvascular anastomosis. When limb-sparing surgery is made impossible, amputation is the only option. Proximal amputation such as forequarter amputation (FQA) causes considerable morbidity, but is nevertheless warranted for carefully selected patients for cure or palliation. 116 patients treated in 1985 - 2006 were included in the study. Of these, 93 patients treated with limb-sparing surgery and microvascular reconstructive surgery after resection of extremity STS. 25 patients who underwent FQA were also included. Patients were identified and their medical records retrospectively reviewed. In all, 105 free flap procedures were performed for 103 patients. A total of 95 curatively treated STS patients were included in survival analysis. The latissimus dorsi, used in 56% of cases, was the most frequently used free flap. Free flap success rate was 96%. There were 9% microvascular anastomosis complications and 15% wound complications. For curatively treated STS patients, local recurrence-free survival at 5 years was 73.1%, metastasis-free survival 58.3%, and overall disease-specific survival 68.9%. Functional results were good, with 75% of patients regaining normal or near-normal function after lower extremity, and 55% after upper extremity STS resection. Among curatively treated forequarter amputees, 5-year disease-free survival was 44%. In the palliatively treated group median time until disease death was 14 months. Microvascular reconstruction after extremity soft tissue sarcoma resection is safe and reliable, and produces well-healing wounds allowing early oncological treatment. Oncological outcome after these procedures is comparable to that of other extremity sarcoma patients. Functional results are generally good. Forequarter amputation is a useful treatment option for soft tissue tumors of the shoulder girdle and proximal upper extremity. When free flap coverage of extended forequarter amputation is required, the preferable flap is a fillet flap from the amputated extremity. Acceptable oncological outcome is achieved for curatively treated FQA patients. In the palliatively treated patient considerable periods of increased quality of life can be achieved.Pehmytkudossarkoomat (PKS) ovat harvinaisia pahanlaatuisia kasvaimia (n 1% aikuisten kasvaimista) joista valtaosa ilmenee raajoissa. Raajan PKS:n nykyaikainen hoito perustuu raajan säästävään kirurgiaan ja sädehoitoon. Uusiutumisen ehkäisemiseksi tarvitaan 2.5 cm:n tervekudosmarginaali, ja laajat luu- ja pehmytkudospuutokset vaativat usein korjaavan kirurgian menetelmiä. Kun paikalliset tai varrelliset pehmytkudoskielekkeet eivät riitä, tulee kyseeseen vapaa mikrovaskulaarinen kieleke. Kielekkeen verenkierto palautetaan yhdistämällä sen verisuonet mikrokirurgista tekniikkaa käyttäen kohdealueen verisuoniin. Kun raajaa ei voida säästää, on amputaatio ainoa vaihtoehto. Proksimaaliset amputaatiot kuten forequarter-amputaatio (FQA) (yläraajan, lapaluun ja osittainen solisluun poisto) ovat tarkoin valittujen potilaiden kohdalla aiheellisia. Amputaation tavoite on joko syövän parantaminen (kuraatio) tai oireiden leivittäminen (palliaatio). Tutkimukseen sisällytettiin 116 vuosina 1985 – 2006 hoidettua potilasta. Raajan PKS hoidettiin 93:lla potilaalla raajan säästävällä kirurgialla ja mikrovaskulaarisella kielekekorjauksella. Myös 25 FQA:n läpikäynyttä potilasta sisällytettiin. Potilaiden sairaskertomustietoja tarkasteltiin retrospektiivisesti. Kaikkiaan tehtiin 105 mikrovaskulaarista kielekettä 103:lle potilaalle. Onkologisiin eloonjäämisanalyyseihin sisällytettiin 95 kuratiivisesti hoidettua PKS-potilasta. Yleisimmin käytetty kieleke oli latissimus dorsi-kieleke (56%). Kielekesiirroista onnistuivat 96%. Mikrovaskulaarisen verisuoniliitoksen komplikaatio esiintyi 9%:ssa ja haavan paranemisongelmaa 15%:ssa tapauksista. Viiden vuoden paikallisuusiutuma-vapaa ennuste oli 73.1%, metastaasivapaa ennuste 58.3% ja elossaoloennuste 68.9%. Jopa 75% alaraajan ja 55% yläraajan PKS:n vuoksi leikatuista potilaista saavutti seurannassa normaalin tai lähes normaalin raajan toiminnan. Kuratiivisen FQA:n läpikäyneiden potilaiden viiden vuoden elossaoloennuste oli 44%. Palliatiivisen amputaation jälkeen mediaanielossaoloaika oli 14 kuukautta. Mikrovaskulaarinen kielekerekonstruktio on turvallinen ja luotettava tapa korjata PKS-leikkauksen jälkeisiä kudospuutoksia. Mahdollisimman hyvät olosuhteet haavojen paranemiselle luodaan, eikä onkologisten hoitojen aloitus viivästy. Mikrovaskulaarisilla kielekkeillä hoidettujen potilaiden onkologinen ennuste ei eroa muiden PKS-potilaiden ennusteesta. Toimenpiteen jälkeen raajan toiminta säilyy hyvin. FQA on käyttökelpoinen menetelmä hartian seudun kasvainten hoidossa. Laajennetun FQA:n jälkeisen kudospuutoksen korjauksessa suositeltavin mikrovaskulaarikieleke on amputoidusta raajasta otettu ”fillet-flap”-kieleke. Kuratiivisesti hoidettujen potilaiden ennuste on hyväksyttävä, ja palliatiivisesti hoidettujen potilaiden oireita voidaan lievittää tehokkaasti

Ampumavammat

English summar

Co-Adaptive Control of Bionic Limbs via Unsupervised Adaptation of Muscle Synergies

Objective: In this work, we present a myoelectric interface that extracts natural motor synergies from multi-muscle signals and adapts in real-time with new user inputs. With this unsupervised adaptive myocontrol (UAM) system, optimal synergies for control are continuously co-adapted with changes in user motor control, or as a function of perturbed conditions via online non-negative matrix factorization guided by physiologically informed sparseness constraints in lieu of explicit data labelling. Methods: UAM was tested in a set of virtual target reaching tasks completed by able-bodied and amputee subjects. Tests were conducted under normative and electrode perturbed conditions to gauge control robustness with comparisons to non-adaptive and supervised adaptive myocontrol schemes. Furthermore, UAM was used to interface an amputee with a multi-functional powered hand prosthesis during standardized Clothespin Relocation Tests, also conducted in normative and perturbed conditions. Results: In virtual tests, UAM effectively mitigated performance degradation caused by electrode displacement, affording greater resilience over an existing supervised adaptive system for amputee subjects. Induced electrode shifts also had negligible effect on the real world control performance of UAM with consistent completion times (23.91 +/- 1.33 s) achieved across Clothespin Relocation Tests in the normative and electrode perturbed conditions. Conclusion: UAM affords comparable robustness improvements to existing supervised adaptive myocontrol interfaces whilst providing additional practical advantages for clinical deployment. Significance: The proposed system uniquely incorporates neuromuscular control principles with unsupervised online learning methods and presents a working example of a freely co-adaptive bionic interface.Peer reviewe

Further validation of the Toronto extremity salvage score for lower extremity soft tissue sarcoma based on Finnish patients

The most widely used patient-reported outcome (PRO) measure for soft tissue sarcoma (STS) patients is the Toronto Extremity Salvage Score (TESS). The aim of the study was to validate and test the reliability of the TESS for patients with lower extremity STS based on Finnish population data. Patients were assessed using the TESS, the QLQ-C30 Function and Quality of life (QoL) modules, the 15D and the Musculoskeletal tumour Society (MSTS) score. The TESS was completed twice with a 2- to 4-week interval. The intraclass correlation coefficient (ICC) was used for test-retest reliability. Construct validity was tested for structural validity and convergent validity. Altogether 136 patients completed the TESS. A ceiling effect was noted as 21% of the patients scored maximum points. The ICC between first and second administration of the TESS was 0.96. The results of exploratory factor analysis together with high Cronbach's alpha (0.98) supported a unidimensional structure. The TESS correlated moderately with the MSTS score (rho = 0.59, p < 0.001) and strongly with the mobility dimension in the 15D HRQL instrument (rho = 0.76, p < 0.001) and the physical function in QLQ-C30 (rho = 0.83, p < 0.001). The TESS instrument is a comprehensive and reliable PRO measure. The TESS may be used as a validated single index score, for lower extremity STS patients for the measurement of a functional outcome. The TESS seems to reflect patients' HRQoL well after the treatment of lower extremity soft tissue sarcomas. (C) 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Outcome and rational management of civilian gunshot injuries to the brain—retrospective analysis of patients treated at the Helsinki University Hospital from 2000 to 2012

Treatment of gunshot wounds of the brain (GSWB) remains controversial and there is high variation in reported survival rates (from  90%) depending on the etiology and country. We retrospectively analyzed the outcome of a series of consecutive GSWB patients admitted alive to a level 1 trauma center in a safe high-income welfare country with a low rate of homicidal gun violence.Peer reviewe

Measuring functional outcome in upper extremity soft-tissue sarcoma : Validation of the Toronto extremity salvage score and the QuickDASH patient-reported outcome instruments

Interest in functional outcome (FO) and health-related quality of life (HRQL) in extremity soft-tissue sarcoma (STS) patients has increased. The aim of this study was to validate two FO questionnaires for upper extremity STS patients: the Toronto Extremity Salvage Score (TESS) and short version of the Disability of Arm, Shoulder and Hand (QuickDASH), based on Finnish population data. A multi-center study was conducted at two academic sarcoma centers. Surgically treated upper extremity STS patients were invited to participate. Patients completed the TESS and the QuickDASH with HRQL questionnaires the 15D and the QLQ-C30. The scores were analyzed and compared. Fifty-five patients with a mean follow-up period of 4.7 years were included. Mean age was 63 years (standard deviation [SD] 14.6). The mean score for TESS was 88.5 (SD 15.1) and for QuickDASH 17.8 (SD 19.6). The QuickDASH had a statistically significantly better score coverage. A ceiling effect was noted, 27% and 20% for TESS and QuickDASH, respectively. The TESS and QuickDASH scores were strongly correlated ( r =-0.89). The TESS score strongly correlated with the QLQ-C30 ( r = 0.79) and the 15D score ( r = 0.70). The QuickDASH score correlated strongly with the QLQ-C30 score ( r =-0.71) and moderately with the 15D score ( r =-0.56). The TESS score had a statistically significantly stronger correlation with the 15D score than QuickDASH ( p < 0.005). Both the TESS and the QuickDASH provide reliable scores for assessing FO in upper extremity STS patients. The QuickDASH has a better coverage, whereas TESS showed a stronger correlation to HRQL scores. (c) 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )Peer reviewe

Functional Outcome Measurement in Patients with Lower-Extremity Soft Tissue Sarcoma : A Systematic Literature Review

The importance of functional outcome (FO) in the treatment of patients with extremity soft tissue sarcoma (STS) has been increasingly recognized in the last three decades. This systematic review aimed to investigate how FO is measured in surgically treated lower-extremity STS patients.Peer reviewe

Soft Tissue Sarcoma of Lower Extremity : Functional Outcome and Quality of Life

Publisher Copyright: © 2021, The Author(s).Background: Few studies have focused on patient-related factors in analyzing long-term functional outcome and health-related quality of life (HRQoL) in patients with postoperative lower extremity soft tissue sarcoma (STS). Objective: The purpose of this study was to investigate factors associated with postoperative functional outcome and HRQoL in patients with lower extremity STS. Methods: This cross-sectional study was performed in a tertiary referral center using the Toronto Extremity Salvage Score (TESS), Quality-of-Life Questionnaire (QLQ)-C30 and 15 Dimension (15D) measures. Functional outcome and HRQoL data were collected prospectively. All patients were treated by a multidisciplinary team according to a written treatment protocol. Results: A total of 141 patients who had undergone limb-salvage surgery were included. Depending on the outcome measure used, 19–51% of patients were completely asymptomatic and 13–14% of patients had an unimpaired HRQoL. The mean score for TESS, 15D mobility score, and QLQ-C30 Physical Functioning scale were 86, 0.83, and 75, respectively, while the mean score for 15D was 0.88, and 73 for QLQ-C30 QoL. Lower functional outcome was statistically significantly associated with higher age, higher body mass index (BMI), and the need for reconstructive surgery and radiotherapy, while lower HRQoL was statistically significantly associated with higher age, higher BMI, and reconstructive surgery. Conclusion: Functional outcome and HRQoL were generally high in this cross-sectional study of patients with STS in the lower extremity. Both tumor- and treatment-related factors had an impact but patient-related factors such as age and BMI were the major determinants of both functional outcome and HRQoL.Peer reviewe