Published online Nov 24, 2023. doi: 10.5306/wjco.v14.i11.471
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
Flap reconstruction can extend the surgical field or tumor bed because of flap elevation or dissection of recipient vessels during resection of superficial soft tissue sarcomas. There is currently no method describing extension of the surgical field.
Extension of the surgical field cannot be predicted based on preoperative images for flap reconstruction after superficial soft tissue sarcoma resection. Knowledge of the surgical field extension is important information for evaluation of recurrence images or possible postoperative radiation.
A theoretical CD-grading system was developed consisting of C and D values in the surgical field extension. The C-value represents the flap beyond the nearby large joint and the D-value pertains to a deeper extension.
C1/D1 and C0/D0 are positive and negative values, respectively. With a known location, C values are "p" (proximal), "d" (distal), and "b" (in the tumor bed). The description method is as follows: flap type, CxDx [x = 0, 1, p, d or b].
Classification and possible values are shown in the tables (transpositional fascial flap/propeller, pedicled, and free flaps). Four representative patients with subcutaneous sarcomas who underwent reconstruction using fasciocutaneous flaps are presented.
The new grading system can give values for tumor bed extension after flap reconstruction following superficial soft tissue sarcoma resection. The description of whether or not the operative field has been extended due to reconstruction is thought to be important information for evaluation of recurrence images.
Clinical use of assembled clinical data would be necessary and some modification may be required for improvement, especially if the new grading system is modified for any part of bone and soft tissue sarcomas.