RESUMO
We report a case of palliative surgery in a 73-year-old patient with metastatic plantar sarcoma. The patient underwent resection and irradiation of an undifferentiated spindle cell sarcoma in the right plantar region. The wound was not closed and systemic metastases were observed. The chief complaint of the patient on his first visit to our department was difficulty walking due to pain in the right plantar region. Since we were unsuccessful in relieving the pain with conservative treatment, we decided to perform a palliative free tissue transfer to the right plantar. The surgery was successful, the skin ulcer healed, and the pain was relieved after the surgery. When performing palliative surgery, more detailed preoperative management and planning are necessary to achieve a successful outcome. The selection of the flaps according to the local lesion and metastatic lesions and changes in the local hemodynamics should be considered when planning.
RESUMO
OBJECTIVE: According to previous reports, remote ischaemic preconditioning (RIPC) is a "delay" procedure that is highly likely to be useful for preventing skin flap necrosis. Differences in the extent of necrosis in rat dorsal skin flaps when different clamping times were used in RIPC were compared among the four groups described below. METHODS: Group A was a control group in which no prior ischaemic area was created, and both back legs were devascularised for 15 min in Group B, 30 min in Group C, and 60 min in Group D. The experiments were performed on 10 rats in each group, and the surviving area was measured. One-way analysis of variance (ANOVA) and Tukey's multiple comparison test were used for analysis, with p < 0.05 regarded as significant. RESULTS: The surviving area of the skin flap was 15.4 ± 1.8 cm(2) in Group A, 15.4 ± 2.0 cm(2) in Group B, 17.9 ± 2.0 cm(2) in Group C, and 19.2 ± 3.4 cm(2) in Group D, with significant differences between Groups A and D and between Groups B and D. CONCLUSIONS: RIPC consisting of 60 min of ischaemic preconditioning may be clinically useful as a method of preventing skin flap necrosis.