Doctors of the Department of Orthopedic Surgery at K Hospital have just successfully performed surgery to remove a giant soft tissue tumor from the abdominal wall. The very large tumor left a hole in the abdominal wall, which was surgically removed and reconstructed using an autologous flap.
Subjectively did not go to the doctor for a recurrent abdominal tumor with a diameter of 20cm.
Patient TCNh, 49 years old, in Ha Nam had surgery to remove an abdominal tumor 1 year ago at another medical facility, but at that time the tumor was small, the surgery went smoothly, the pathological result was a low-grade malignant fibrodermoid cyst. After a while, the tumor recurred in the abdominal wall and grew very quickly, patient Nh. subjectively did not go for a follow-up examination, only when the tumor was too large causing difficulty in daily life, the patient went to K Hospital for examination, the initial result showed that the tumor had reached a diameter of about 20cm.
Through examination and abdominal MRI, it was found that the tumor above the navel was 166x170mm in size, with irregular edges, eroding and causing a defect in the abdominal wall muscles for a length of 26mm, spreading into the abdominal cavity, approaching the superior mesenteric vascular bundle. However, according to the initial assessment, the tumor had not invaded the blood vessels and organs in the abdominal cavity. Pathological anatomy was fibrodermoid sarcoma invading skeletal muscle tissue.
After receiving the patient, doctors from the Department of Orthopedic Surgery, K Hospital coordinated a consultation to develop a treatment plan for the patient.
Determining that this was a difficult case because the tumor was very large and had spread into the abdomen, the doctors of the Department of Musculoskeletal Surgery consulted and determined that surgery was needed to remove the tumor and reconstruct the patient. The surgical team consulted carefully and coordinated with the doctors of the Department of Anesthesia and Resuscitation on the anesthesia plan, blood reserve, establishment of central venous lines, and close monitoring of the patient throughout the surgery to have a plan to promptly handle developments during the surgery.
Due to the nature of this difficult case, with a high risk of complications, especially blood loss, in addition to planning the surgery meticulously and accurately, the team also explained thoroughly and encouraged the patient and family.
Determined to successfully perform difficult surgery
With the determination to treat the patient and his family, along with careful preparation, the surgical team of the Department of Musculoskeletal Surgery of K Hospital, including Specialist II Hoang Tuan Anh - Head of the Department, Master, Resident Doctor Hoang Le Minh, Specialist II Hoang Van Nha, performed wide tumor excision surgery and created a latissimus dorsi flap to cover the defect, along with placing prolene mesh to restore the abdominal wall.
Intraoperative evaluation of a large abdominal wall tumor, above the navel, approximately 20cm in size, invading the rectus abdominis muscle, with heavy bleeding due to increased vascularity. The patient underwent extensive excision of the lesion, abdominal wall restoration using a latissimus dorsi muscle flap combined with placement of prolene mesh. The resection was evaluated to show no tumor.
Specialist II Doctor Hoang Tuan Anh - Head of the Department of Musculoskeletal Surgery shared: "We consider patient Nh.'s case to be a difficult and rare disease. The patient has a very large soft tissue tumor that damages all layers of the abdominal wall, skin, muscles and peritoneum; the tumor has a fast-growing nature; therefore, it is necessary to perform early surgery to remove it to ensure the patient's health against the risk of tumor rupture.
During the surgery, the team also encountered many challenges such as the risk of blood loss during surgery; the location of the tumor; the surgery to remove the tumor combined with creating a defect, so all options were calculated and considered very carefully."
After surgery, the patient was carefully monitored and cared for because the large tumor caused a large abdominal wall defect and a loss of much muscle tissue. The patient continued to undergo surgery to remove thin skin from the thighs on both sides and graft skin to cover the soft tissue defect (the granulation tissue had developed well).
Fortunately, with the determination of the doctors, the patient and his family, after the combined surgery and plastic surgery, the patient's incision progressed well, gradually recovered, and the patient was discharged from the hospital for regular monitoring and evaluation.
Through the case of patient Nh., doctors recommend that with soft tissue tumors that develop quickly or are located deep (under the fascia), patients should go to medical facilities specializing in oncology to receive advice and receive the correct treatment regimen, avoiding misdiagnosis of the disease leading to incorrect treatment regimens, making it difficult to treat and monitor the patient.
Source: https://nhandan.vn/phau-thuat-ket-hop-tao-hinh-vat-tu-than-cho-benh-nhan-u-phan-mem-khong-lo-thanh-bung-post889495.html
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