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Weichgewebesarkome an Unterarm und Hand

Plastisch-chirurgische Behandlung

Soft-tissue sarcoma of the forearm and hand

Plastic surgical management

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Zusammenfassung

Weichgewebesarkome distal des Ellenbogengelenkes gehören zu eher seltenen Neoplasien und bedürfen spezieller multimodaler Therapie. Die weite Exzision histologisch in sano (R0) oder in gesonderten Fällen die Ablation von Gliedmaßen ist die prognostisch beste Therapie zur Verhütung von Lokalrezidiven.

In der Zeit zwischen 1995 und 2005 wurden in unserer Klinik bei 20 Patienten Sarkomresektionen an Unterarm bzw. Hand durchgeführt und das Patientengut retrospektiv betrachtet. Das Durchschnittsalter betrug 48 Jahre (1–83 Jahre). In 9 Fällen waren Frauen betroffen, 11 Patienten waren männlich. Fünf der Patienten waren bereits auswärts voroperiert und der Tumor nicht in sano reseziert. Die durchschnittliche Follow-up-Zeit betrug 42 Monate. Zwei der an unserer Klinik operierten Patienten erlitten nach histologischer R0-Resektion einen Rezidivtumor. Der am häufigsten vorkommende Tumortyp war das maligne fibröse Histiozytom/Myxofibrosarkom in 10 Fällen. Sechs Patienten benötigten eine freie mikrovaskuläre Lappentransplantation zur Defektdeckung. Bei 3 Patienten konnte der Defekt primär verschlossen bzw. mit Spalthaut gedeckt werden, ein Patient erhielt einen lokalen Verschiebe-Schwenk-Lappen und bei einem weiteren Patienten konnte der Defekt mit einer gestielten Lappenplastik gedeckt werden. Keine Möglichkeit des Extremitätenerhaltes ergab sich in 9 Fällen. Eine begleitende Bestrahlungstherapie erhielten 10 Patienten, eine Chemotherapie 4 Patienten (neoadjuvante Chemotherapie erhielten 2 Patienten). R0-Resektion war in 18 Fällen möglich.

Die Resultate zeigen, dass die plastisch-chirurgische Rekonstruktion heutzutage als integraler Bestandteil moderner Sarkomtherapie unverzichtbar ist und dadurch im Rahmen einer multimodalen Therapie in vielen Fällen auch an Hand und Unterarm extremitätenerhaltend operiert werden kann.

Abstract

Radical tumor resection (R0) is the main therapeutic goal in the treatment of sarcomas of the forearm and hand. Plastic reconstructive procedures play a key role in limb salvage by coverage of complex defects. Sophisticated reconstructive techniques are required with the forearm and hand. Twenty patients with soft-tissue sarcomas of the hand and forearm were treated in our department between January 1995 and January 2005. Eleven were male and nine were female. The average age was 48 years. The most common tumor was myxoid fibrous histiocytoma, followed by synovial cell sarcoma. Six patients received free microvascular transplantations to cover their defects. Mesh graft or primary closure was possible in three cases; one patient received a local flap and one a pedicled flap. In nine cases preserving the limb was not possible. Ten patients received radiation and four got chemotherapy (two with neoadjuvant chemotherapy). In 18 cases histologic R0 resection was possible, in two cases R1 resection. Two patients suffered from tumor reccurrence after R0 resection. The average follow-up-time was 42 months. These results show the necessity of plastic surgical reconstruction of the forearm and hand as an integral component of modern sarcoma therapy. Multidisciplinary cooperation is mandatory for adequate treatment.

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Authors and Affiliations

  1. Hand, Plastische und Rekonstruktive Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland

    M. Müller, B. Bickert & G. Germann

  2. Klinik für Plastische, Hand- und Rekonstruktive Chirurgie, Hofheim, Deutschland

    M. Sauerbier

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  1. M. Müller
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  2. B. Bickert
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  3. G. Germann
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  4. M. Sauerbier
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Correspondence to M. Müller.

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Müller, M., Bickert, B., Germann, G. et al. Weichgewebesarkome an Unterarm und Hand. Chirurg 79, 682–688 (2008). https://doi.org/10.1007/s00104-008-1529-3

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