title: Microsurgical approach for unusual and unexpected malignant fibrous histiocytoma of the forearm: A case report.
abstract: Soft tissue sarcomas are rare tumors with a dismal prognosis. Among the most common histological types of sarcomas of the extremities, malignant fibrous histiocytoma (MFH) is the one with the highest incidence. Surgery is considered to be the first choice of treatment for MFH. To the best of our knowledge, this is the first case report in the literature of a patient with MFH within the abductor pollicis longus (APL) muscle. This unusual location was also unexpected by the treating surgeons, as the preoperative magnetic resonance imaging localized the tumor inside a different muscle. A 79-year-old Caucasian man presented with a swelling in the middle third of the dorsal aspect of the left forearm. MFH was diagnosed following biopsy and instrumental diagnostic examinations. Surgical excision and simultaneous reconstruction was performed by the same microsurgical team, achieving an excellent functional outcome. The present case highlights the significance of microsurgical approach for improving strategic planning in oncologic surgery. Accurate surgical dissection, performed by a team of microsurgeons, allowed for the identification of the unusual and unexpected tumor localization within the APL muscle. For this reason, a change of surgical strategy allowed for preservation of the extensor digitorum communis muscle, which would otherwise have to be resected, with tendon transfer and successful restoration of the thumb abduction function.
authors.affiliation: Department of General Microsurgery and Hand Surgery, Fabia Mater Hospital, I-00171 Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: D'Orazi
authors.affiliation: Department of General Microsurgery and Hand Surgery, Fabia Mater Hospital, I-00171 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Panunzi
authors.affiliation: Biomechanics and Movement Analysis Laboratory, Physical Medicine and Rehabilitation, Sapienza University, I-00161 Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Paoloni
authors.affiliation: Department of General Microsurgery and Hand Surgery, Fabia Mater Hospital, I-00171 Rome, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Ortensi
authors.affiliation: Department of General Microsurgery and Hand Surgery, Fabia Mater Hospital, I-00171 Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Anichini
authors.affiliation: Department of General Microsurgery and Hand Surgery, Fabia Mater Hospital, I-00171 Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Cialini
authors.affiliation: Pathology Service S.A.MAR., I-00167 Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nardoni
authors.affiliation: Department of Surgical Sciences, Sapienza University, I-00161 Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Urciuoli
authors.affiliation: Department of Surgical Sciences, Sapienza University, I-00161 Rome, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pasta
authors.affiliation: Department of General Microsurgery and Hand Surgery, Fabia Mater Hospital, I-00171 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ortensi
keywords: forearm; malignant fibrous histiocytoma; microsurgical technique; sarcoma; tendon transfer