Autogenous arterial and venous reconstruction for femoral vein leiomyosarcoma--a case report.
This report describes the removal of a large, symptomatic leiyomyosarcoma arising from the proximal femoral vein necessitating removal of the femoral venous and arterial circulations. Reconstruction was accomplished with autologous vein and initial coverage with ipsilateral rectus abdominus flap. Persistent, early postoperative lymphatic leak and groin sepsis secondary to staph aureus was managed with reoperation and coverage with contralateral rectus abdominus muscle flap. Negative pressure dressing device was used as a wound management adjunct and splint thickness skin graft providing final successful coverage. Two years following the operation the patient was without evidence of disease, had a patent vascular reconstruction and a well healed groin. Femoral vein leiyomyosarcoma is a rare vascular tumor, which is especially challenging to manage in the proximal location. Successful outcome is predicated on revascularization with autologous vein and on a multidisciplinary approach using various soft tissue coverage strategies and wound management adjuncts.
Propper
Brandon
B
Department of Surgery, Wilford Hall Medical Center USAF, Uniformed Services University of the Health Sciences, Lackland AFB, Texas, USA. propper@uthscsa.edu
Zonies
David
D
Smith
David
D
Rasmussen
Todd E
TE
D000369:Aged, 80 and over; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005268:Femoral Vein / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007890:Leiomyosarcoma / Q000473:pathology / Q000601:surgery*; D054843:Negative-Pressure Wound Therapy; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation*; D018805:Sepsis / Q000209:etiology / Q000628:therapy; D016038:Skin Transplantation; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000473:pathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014945:Wound Healing