Aims

To evaluate the incidence, patient demographics, primary tumour characteristics and treatment modalities of patients with radiation induced soft tissue sarcoma (RISTS) presenting to the East Midlands Sarcoma Service at Nottingham City Hospital.

We reviewed 100 consecutive primary sarcoma patients identified from coding records from January 2009 to April 2011. A computerised system was used to access theatre records, and operative details were checked against patient notes to ensure accuracy. Data on demographics, pathology, surgical and oncological management was collected.

Of the 100 patients reviewed, 52 were male and 48 female with an average age of 64.9 years (range 23–102 years). Of the 100 operations performed, 13 had primary reconstruction with a myocutanoeus flap, of which 9 varieties were used. Twenty-five patients had reconstruction with a split or full thickness skin graft and 9 patients had a limb amputation. Length of inpatient stay ranged from 0 to 63 days and was greatest for our amputee's. Mean operative time did not increase significantly with rise in case complexity. 31 of our patients received post-operative radiotherapy, one patient had induction radiotherapy whilst another had induction chemotherapy.

5 out of the 100 patients underwent re-excision due to incomplete margins being obtained at primary wide local excisions. We had one patient with a failed free latissimus dorsi flap, in which secondary reconstruction with pedicled gastrocnemius and skin grafting was successful. One patient had a scalp flap following a re-excision of a positive margin of an angiosarcoma.

Using a combined oncological orthopaedic and reconstructive plastic surgery approach, in our centre 38% of patients require some form of soft tissue reconstruction following tumour resection, with 13% of all patients requiring microvascular flap reconstruction. We have a 9% amputation rate, which is comparable with other published series.

Reconstruction following soft tissue sarcoma is complex and highly demanding, the challenges being best met by a combined orthoplastic surgical team.

Introduction

We aimed to ascertain the oncological outcome of patients undergoing an amputation for sarcoma in our unit.

Objectives: It is common for breast surgeons to excise impalpable tumours and fine-wire localisation is commonly deployed by breast radiologists to facilitate such surgery. Pre-operative localisation can be achieved using conventional ultrasound but this necessitates co-ordination with the radiology department.

Methods: We have utilised the SonoSite (SonoSite Inc, Bothell, WA) portable ultrasound system available widely in operating theatres for insertion of vascular lines and perineural catheters, for localisation of deep impalpable tumours.

Results: Two patients who had undergone mid-forearm amputations for synovial sarcoma are presented. The first presented with axillary recurrence of his tumour. MRI scanning of his stump revealed two lesions suspicious of recurrence. Both were impalpable initially. The lesions were identified using the SonoSite and excision biopsy performed. Histologically the lesions were neuromata. The second patient had imaging in keeping with neuromata and again the Sonosite was utilised to detect the lesions and facilitate removal.

Discussion: Sonosite portable ultrasound machines are readily available in the operating theatre and may be utilised to aid removal of tumours. They do not replace other imaging but can make surgery less traumatic in that smaller incisions may be used.