Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 24, 2023; 14(11): 471-478
Published online Nov 24, 2023. doi: 10.5306/wjco.v14.i11.471
System describing surgical field extension associated with flap reconstruction after resection of a superficial malignant soft tissue tumor
Akio Sakamoto, Takashi Noguchi, Shuichi Matsuda
Akio Sakamoto, Takashi Noguchi, Shuichi Matsuda, Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
Author contributions: Sakamoto A developed the classification and drafted the manuscript; Noguchi T and Matsuda S participated in the study design; All authors read and approved the final manuscript.
Institutional review board statement: Analysis of clinical data accumulation in patients with bone and soft tissue tumors. Retrospective study.
Informed consent statement: The patients represented in this study were informed that the data from the case would be de-identified and used in a journal publication. There is a specific signed document because the analysis used anonymous clinical data that were obtained after each patient had been notified at the Kyoto University home page that the data could be used for a clinical study.
Conflict-of-interest statement: We, the authors, declare no conflicts of interest regarding our manuscript entitled “A system describing surgical field extension associated with flap reconstruction after resection of a malignant soft tissue tumor.”
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akio Sakamoto, MD, PhD, Adjunct Professor, Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan. akiosaka@kuhp.kyoto-u.ac.jp
Received: August 29, 2023
Peer-review started: August 29, 2023
First decision: September 14, 2023
Revised: September 24, 2023
Accepted: October 13, 2023
Article in press: October 13, 2023
Published online: November 24, 2023
Processing time: 84 Days and 17.6 Hours
Abstract
BACKGROUND

Flap reconstruction after resection of a superficial malignant soft tissue tumor extends the surgical field and is an indicator for potential recurrence sites.

AIM

To describe a grading system for surgical field extension of soft tissue sarcomas.

METHODS

Grading system: CD-grading is a description system consisting of C and D values in the surgical field extension, which are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle, respectively. C1/D1 are positive values and C0/D0 are negative. With a known location, 1/0 values can be "p" (proximal), "d" (distal), and "b" (in the tumor bed), and the description method is as follows: flap type, CxDx [x = 0, 1, p, d or b].

RESULTS

Four representative patients with subcutaneous sarcomas who underwent reconstruction using fasciocutaneous flaps are presented. The cases involved a distal upper arm (elbow) synovial sarcoma reconstructed using a pedicled latissimus dorsi (pedicled flap: CpDp); a distal upper arm (elbow) pleomorphic rhabdomyosarcoma reconstructed using a transpositional flap from the forearm (transpositional flap: CdD0); an undifferentiated pleomorphic sarcoma in the buttocks reconstructed using a transpositional flap (transpositional flap: C0D0); and a myxofibrosarcoma in the buttocks reconstructed using a propeller flap from the thigh (pedicled flap: CdDd).

CONCLUSION

The reconstruction method is chosen by the surgeon based on size, location, and other tumor characteristics; however, the final surgical field cannot be determined based on preoperative images alone. CD-grading is a description system consisting of C and D values in the surgical field extension that are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle, respectively. The CD-grading system gives a new perspective to the flap reconstruction classification. The CD-grading system also provides important information for follow-up imaging of a possible recurrence.

Keywords: Soft tissue, Sarcoma, Surgery, Sarcoma, Grading system, Surgical flap

Core Tip: Flap reconstruction after resection of a superficial malignant soft tissue tumor extends the surgical field and is an indicator for potential recurrence sites. CD-grading is a description system consisting of C and D values in the surgical field extension that are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle, respectively. C1/D1 and C0/D0 are positive and negative values, respectively. The CD-grading system gives a new perspective to flap reconstruction classification. The CD-grading system also provides important information for follow-up imaging of a possible recurrence.