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Case 1.6
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
The clinically relevant differential of any lower limb trauma classification is whether the injury is low or high energy, but more recent evidence suggests that arterial injury also affects outcomes, even in the context of continued limb perfusion.
Acute Limb Ischaemia
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
The second point is that as you progress in the station things get more and more challenging. Things also become more difficult to answer because you realise that whatever you say may be wrong in someone else's opinion. For example, over the course of my career I have worked with “aggressive” interventional radiologists/vascular surgeons who will treat most lesions they see. On the other hand, I have worked with “conservative” interventional radiologists/vascular surgeons who have a far more cautious approach. As for me, I try to remain pragmatic and sensible. I also try to think out of the box and look backwards from the future onto the current case I am doing. I consider myself doing something and then consider the possible risks and consequences. I also weigh up the benefits of doing this procedure. In this context, I have genuinely seen lots of dissections requiring stents, bypasses, and they have occasionally resulted in the need for a major amputation. As such, if I have improved the patient's lower limb perfusion, I would be reluctant to do something that may completely undo the good work I have just done. My position in cases like this is indeed: “PERFECTION IS THE ENEMY OF GOOD.” Of course, if this was a severe SFA stenosis and flow limiting, I would have treated it.
Resource-Limited Environment Plastic Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Johann A. Jeevaratnam, Charles Anton Fries, Dimitrios Kanakopoulos, Paul J. H. Drake, Lorraine Harry
Assess for circumferential limb burns, which may be compromising limb perfusion. If any concern exists regarding either venous return – which would likely occur first – or arterial inflow, perform emergency escharotomy.
Risk factors for the development of local recurrence in extremity soft-tissue sarcoma
Published in Expert Review of Anticancer Therapy, 2022
Fabio Tirotta, Raza Sayyed, Robin L Jones, Andrew J Hayes
Despite these concerns, it remains the case that surgery is the primary treatment for localized epithelioid sarcoma. The role of isolated limb perfusion (ILP) is currently unclear, with insufficient data to support its use other than in in-transit metastases, multifocal or refractory disease [31,32]. As over 90% of epithelioid sarcomas display INI1 loss leading to oncogenic dependence on the transcriptional repressor EZH2, early data with tazemetostat, a selective inhibitor of EZH2, has demonstrated some encouraging results for patients with advanced disease [32]. Retrospective studies have shown that conventional chemotherapy has similar response rates to tazemetostat in the advanced setting [33,34]. However, the favorable side effect profile of tazemetostat makes it an attractive option to consider in the management of this particular subtype.
Heating technology for malignant tumors: a review
Published in International Journal of Hyperthermia, 2020
H. Petra Kok, Erik N. K. Cressman, Wim Ceelen, Christopher L. Brace, Robert Ivkov, Holger Grüll, Gail ter Haar, Peter Wust, Johannes Crezee
Selected anatomical sites are suitable for perfusional hyperthermia techniques, generally combined with chemotherapy. One approach is the direct infusion of heated perfusate into the vascular system, for example for hyperthermic isolated limb perfusion (ILP). ILP involves temporarily connecting the circulatory system in the limb of the patient to an external pump to distribute both heat and drugs to the tumor target region, achieving relatively uniform heating and drug delivery in that region. Another approach is to circulate a hyperthermic carrier solution combined with chemotherapeutic agents inside body cavities to provide heating and drug delivery to tumors in the surface of the cavity. An example is Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) which involves circulation of a heated chemotherapeutic solution in the peritoneal cavity to eradicate any microscopic tumors left behind after surgical removal of macroscopic tumor mass [53]. Hyperthermic intrathoracic chemotherapy (HITHOC) is a similar technique for intrathoracic lesions [54]. Hyperthermic Intra-Vesical Chemotherapy (HIVEC®) is another perfusion technique in which the bladder wall is treated by circulating a heated chemotherapy solution inside the bladder [55].
Managing in-transit melanoma metastases in the new era of effective systemic therapies for melanoma
Published in Expert Review of Clinical Pharmacology, 2019
Rebecca L Read, John F Thompson
Treatments can be classified as local, regional or systemic. Local treatments include electrocautery, cryotherapy, laser ablation, intralesional injection of cytotoxic or oncolytic viral agents and electrochemotherapy. Regional treatments include isolated limb perfusion or infusion and, rarely, amputation. Radiotherapy can be utilized as either a local or regional therapy. In some cases, these local and regional treatments can induce a ‘bystander’ or ‘abscopal’ effect resulting in involution of untreated lesions. The efficacy of modern systemic therapies for melanoma means that patients ITMs cannot easily be resected surgically are now candidates for early systemic therapy. In some cases, systemic therapies have been trialed in combination with locoregional therapies. Neoadjuvant systemic therapy has also been used in the clinical trial setting; this enables treatment efficacy to be assessed by serial biopsy, and a reduction in tumor size may facilitate surgery.