Never give up!! A case of limb salvage - Soft tissue sarcoma - Operative Cancer Surgery

Deviating from common topics today we are going to show you an instance of salvaging an upper limb involved by a massive exophytic sarcomatous growth arising from the dorsum of the forearm.
The 59 year old patient presented to our hospital with a large exophytic lesion. He said the reason why he avoided coming to the hospital for nine months was that he was afraid that he would be offered the option of amputation. When he was presented to us he showed us that his hand was fully functional & asked us to consider limb salvage if possible.
It was a pleomorphic sarcoma & there was no radiological evidence of any distal metastases. Limb salvage is of no use if coupled with oncological compromise especially with an aggressive sarcoma.
The lesion was more towards the ulnar side of the forearm.
So it was evident to us in order to have negative margins we need to sacrifice the ulnar nerve and the artery. However we knew that if we can preserve at least the median nerve & the radial artery we would be able to save the hand with more than 50% of its function.
The first task was to reach the bifurcation of the brachial artery at the cubital fossa.You can still see the bifurcation of the brachial artery in this.
We found the median nerve & the radial artery & traced them distally circumnavigating the tumour region.
Once that was done we started entering a deeper plane on the ulnar side & started dissecting distally hoping to pass deep to the tumour region. We were able to do this by sacrificing the ulnar artery & the nerve.
The tumour was excised en block.

The problem was to achieve wound closure. Free flap was not possible since the only supply being the radial artery.we therefore thought of leaving the wound open to granulate.
Histology showed a 5 mm -1 cm negative margin around the lesion.
You are seeing the end result just prior to radiotherapy. The function of the thumb is preserved in spite of an ulnar claw hand. An active thumb is equivalent to 50% of a functional hand.
The histology confirmed an angiosarcoma. Despite its aggressiveness, the patient still has not developed any identifiable metastases. We are happy at this result since limb amputation in sarcoma promises no known survival benefit over limb salvage without oncological compromise.


This channel is dedicated to everyone who is interested in the field of Oncological surgery & is conducted by Dr. Anuruddha Thewarapperuma MBBS MS, a Consultant Cancer Surgeon from Sri Lanka.
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• Category

  Sarcomas, Soft Tissue