title: Vacuum application increases therapeutic safety and allows intensified local radiation treatment of malignant soft-tissue tumors.
abstract: OBJECTIVE
  In order to simplify and improve outcome of radiation therapy and final defect coverage in patients suffering from invasive soft-tissue tumors, brachytherapy and application of V.A.C.uum-assisted closure (V.A.C.) were combined with delaying flap incision.
  
  
  METHODS
  Two patients were excised as radically as possible and brachytherapy tubes were implanted directly on the tumor bed. At the same time, flaps for later defect coverage were preconditioned by circumcision. Brachytherapy and external- beam irradiation were performed directly on the vacuum sponge followed by subsequent defect coverage with the preconditioned flaps.
  
  
  RESULTS
  Excision significantly reduced tumor masses in both patients; in one case sensible and motor function of the involved extremity was clearly improved. V.A.C. coverage allowed repeated brachytherapy and external-beam applications following exact placing of plastic tubes and FLABs on the tumor bed. Sequential irradiation had no effect on neighboring flap tissues, which healed without impairment following transposition.
  
  
  CONCLUSIONS
  Combination of V.A.C. and brachytherapy can effectively replace circumstantial and laborious IORT (intraoperative radiotherapy) procedures. Exact placement of tubes on the tumor bed without subsequent tissue coverage is conserving preconditioned flap tissues, which are transposed for final defect coverage at the end of radiotherapy. However, by circumventing radiation exposure of these tissues, a possible later irradiation sequence can be performed without endangering defect-covering flaps.
authors.affiliation: Department of Plastic and Hand Surgery, University Medical Center Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kopp
authors.forename: Vratislav
authors.initials: V
authors.lastname: Strnad
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Bach
authors.forename: Rolf
authors.initials: R
authors.lastname: Sauer
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
mesh_terms: D000328:Adult; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D017751:Safety Management / Q000379:methods; D012983:Soft Tissue Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014618:Vacuum; D014945:Wound Healing