Objective To assess clinical features and treatment of angiosarcoma.Methods A retrospective study was carried out among seven patients hospitalized for angiosarcoma in the Department of Plastic Surgery,Zhongshan Hospital of Fudan University from January 2004 to March 2012.Clinical behaviors,therapeutic strategies and outcomes of angiosarcoma were analyzed in these patients.Results Of the seven patients,four were male,and three were female,with a median age of 67 years (range,37-77 years).Clinical presentations were various,including irregular ulcerous nodular masses in four patients,localized ulcer in one patient,and irregular erythematous nodules in two patients.All the patients were treated surgically with or without postoperative adjuvant therapy.Pathological examination revealed various degrees of differentiation and atypia of tumor cells,as well as obvious proliferation of endothelial cells,and all of these patients were diagnosed as angiosarcoma.Immunohistochemical analysis revealed a positive staining for CD31 and CD34.After surgical treatment,angiosarcoma recurred in four patients with the median time to the first recurrence being 3.5 months (range,1-6 months),cerebral metastasis occurred in one patient 5 months later,and two patients died.Conclusions Angiosarcoma is a rare and heterogeneous sarcoma with diverse clinical presentations.Local wide resection is the cornerstone of angiosarcoma treatment,and adjuvant therapy may improve its prognosis.

Objective To introduce our experience about the breast reconstruction using latissimus dorsi (LD) flap combined with breast implant.The details of the operative method were prescribed.Methods During the LD mycutaneous breast reconstruction,the insertion of LD was cut off and rotated to fulfil ipsilateral axillary fossa.The breast reconstruction was performed using LD and breast implant.Results 237 cases of breast reconstruction were performed from 1998 to 2017.The axillary contour deformity was successfully restored.The results were satisfied and stable during the follow-up.Conclusions Using proximal LD flap to repair axillary fossa deformity is a safe,effective and easy operating method in LD and implant flap breast reconstruction.

Objective:To review clinical outcomes of extended V-Y latissimus dorsi myocutaneous flap in reconstruction of chest wall defects.Methods:Patients receiving chest wall defect reconstruction with extended V-Y latissimus dorsi myocutaneous flap at Fudan University Zhongshan Hospital from January 2016 to December 2018 were enrolled. Patients were followed up for more than 6 months to detect complications such as blood supply disorder of the flap, wound dehiscence, seroma or tumor recurrence.Results:A total of 16 patients, aged 28-78 years, with an average age of 54.8 years, were included. The chest wall defect size ranged from 10 cm×15 cm to 19 cm×26 cm. Among these cases, 1 case had venous congestion in the distal triangle area of the flap, 1 case had partial wound dehiscence of the flap, 2 cases developed seroma on the back and 2 cases under the flap. All cases healed after changing dressing and drain placement. All the other cases had complete flap survival and primary wound healing. All cases were followed up from 7 to 29 months, with good flap appearance and function and patient satisfaction with results.Conclusions:Chest wall defect reconstruction with V-Y latissimus dorsi myocutaneous flap is safe and reliable. It can repair a large chest wall wound and allow primary closure of the donor site simultaneously, which is worthy of being popularized in chest wall reconstruction.

Objective:To review clinical outcomes of extended V-Y latissimus dorsi myocutaneous flap in reconstruction of chest wall defects.Methods:Patients receiving chest wall defect reconstruction with extended V-Y latissimus dorsi myocutaneous flap at Fudan University Zhongshan Hospital from January 2016 to December 2018 were enrolled. Patients were followed up for more than 6 months to detect complications such as blood supply disorder of the flap, wound dehiscence, seroma or tumor recurrence.Results:A total of 16 patients, aged 28-78 years, with an average age of 54.8 years, were included. The chest wall defect size ranged from 10 cm×15 cm to 19 cm×26 cm. Among these cases, 1 case had venous congestion in the distal triangle area of the flap, 1 case had partial wound dehiscence of the flap, 2 cases developed seroma on the back and 2 cases under the flap. All cases healed after changing dressing and drain placement. All the other cases had complete flap survival and primary wound healing. All cases were followed up from 7 to 29 months, with good flap appearance and function and patient satisfaction with results.Conclusions:Chest wall defect reconstruction with V-Y latissimus dorsi myocutaneous flap is safe and reliable. It can repair a large chest wall wound and allow primary closure of the donor site simultaneously, which is worthy of being popularized in chest wall reconstruction.

Objective:To investigate the effect and quality of life after anterior chest wall reconstruction with titanium plate and mesh due to manubrium tumor resection.Methods:A retrospective analysis was performed from January 2012 to December 2016, a total of 13 patients with primary(11cases) or secondary(2 cases) manubrium tumor, aged 41-72 years(medium aged as 56), underwent oncological resection, following by immediate chest wall reconstruction with titanium plate and titanium mesh. The quality of life was evaluated by EuroQol five dimensions questionnaire (EQ-5D) and EQ-5D visual analogue scale (ED-VAS) before and 3 months after operation. Computed tomographic scan was taken 3 months after operation.Results:All the patients received successful operation. During the perioperative period, 12 cases recovered well without any complications, 1 patient experienced mild paradoxical movement within 9 days after operation and then recovered. The median follow-up period after surgery was 25 months (range from 7 to 41). Computed tomographic scans for the 13 patients showed neither dislocation nor deformation of the titanium plate and mesh 3 months after operation. One patient with chondrosarcoma died as a result of relapse 11 months after surgery. In pain/discomfort dimension, the pre-operation score was 1.85±0.80 and the post-operation score was 1.15±0.38, showing a significant difference( P=0.013). There was no significant difference in scores of other four dimensions between pre- and post-operation( P>0.05). The total score of EQ-5D decreased significantly after the operation (7.08±2.02 vs 5.45±0.52, P=0.010). The pre- and post-operation ED-VAS score was 85.69±7.58 and 92.54±2.53, with a significant difference( P=0.008). Conclusions:The immediate reconstruction of chest wall with titanium plate and mesh after oncological manubrium resection is effective and safe with improvement of the quality of life.

Objective:To investigate the effect and quality of life after anterior chest wall reconstruction with titanium plate and mesh due to manubrium tumor resection.Methods:A retrospective analysis was performed from January 2012 to December 2016, a total of 13 patients with primary(11cases) or secondary(2 cases) manubrium tumor, aged 41-72 years(medium aged as 56), underwent oncological resection, following by immediate chest wall reconstruction with titanium plate and titanium mesh. The quality of life was evaluated by EuroQol five dimensions questionnaire (EQ-5D) and EQ-5D visual analogue scale (ED-VAS) before and 3 months after operation. Computed tomographic scan was taken 3 months after operation.Results:All the patients received successful operation. During the perioperative period, 12 cases recovered well without any complications, 1 patient experienced mild paradoxical movement within 9 days after operation and then recovered. The median follow-up period after surgery was 25 months (range from 7 to 41). Computed tomographic scans for the 13 patients showed neither dislocation nor deformation of the titanium plate and mesh 3 months after operation. One patient with chondrosarcoma died as a result of relapse 11 months after surgery. In pain/discomfort dimension, the pre-operation score was 1.85±0.80 and the post-operation score was 1.15±0.38, showing a significant difference( P=0.013). There was no significant difference in scores of other four dimensions between pre- and post-operation( P>0.05). The total score of EQ-5D decreased significantly after the operation (7.08±2.02 vs 5.45±0.52, P=0.010). The pre- and post-operation ED-VAS score was 85.69±7.58 and 92.54±2.53, with a significant difference( P=0.008). Conclusions:The immediate reconstruction of chest wall with titanium plate and mesh after oncological manubrium resection is effective and safe with improvement of the quality of life.