System describing surgical field extension associated with flap reconstruction after resection of a superficial malignant soft tissue tumor

BACKGROUND Flap reconstruction after resection of a superficial malignant soft tissue tumor extends the surgical field and is an indicator for potential recurrence sites.AIM To describe a grading system for surgical field extension of soft tissue sarcomas.METHODS Grading system:CD-grading is a description system consisting of C and D values in the surgical field extension,which are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle,respectively.C1/D1 are positive values and C0/D0 are negative.With a known location,1/0 values can be"p"(proximal),"d"(distal),and"b"(in the tumor bed),and the description method is as follows:flap type,CxDx[x=0,1,p,d or b].RESULTS Four representative patients with subcutaneous sarcomas who underwent reconstruction using fasciocutaneous flaps are presented.The cases involved a distal upper arm(elbow)synovial sarcoma reconstructed using a pedicled latissimus dorsi(pedicled flap:CpDp);a distal upper arm(elbow)pleomorphic rhabdomyosarcoma reconstructed using a transpositional flap from the forearm(transpositional flap:CdD0);an undifferentiated pleomorphic sarcoma in the buttocks reconstructed using a transpositional flap(transpositional flap:C0D0);and a myxofibrosarcoma in the buttocks reconstructed using a propeller flap from the thigh(pedicled flap:CdDd).CONCLUSION The reconstruction method is chosen by the surgeon based on size,location,and other tumor characteristics;however,the final surgical field cannot be determined based on preoperative images alone.CD-grading is a description system consisting of C and D values in the surgical field extension that are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle,respectively.The CD-grading system gives a new perspective to the flap reconstruction classification.The CD-grading system also provides important information for follow-up imaging of a possible recurrence.

A Novel Twist Deformation Model of Soft Tissue in Surgery Simulation

Real-time performance and accuracy are two most challenging requirements in virtual surgery training.These difficulties limit the promotion of advanced models in virtual surgery,including many geometric and physical models.This paper proposes a physical model of virtual soft tissue,which is a twist model based on the Kriging interpolation and membrane analogy.The proposed model can quickly locate spatial position through Kriging interpolation method and accurately compute the force change on the soft tissue through membrane analogy method.The virtual surgery simulation system is built with a PHANTOM OMNI haptic interaction device to simulate the torsion of virtual stomach and arm,and further verifies the real-time performance and simulation accuracy of the proposed model.The experimental results show that the proposed soft tissue model has high speed and accuracy,realistic deformation,and reliable haptic feedback.

The torsion model of soft tissue in virtual surgery

In order to solve the problem of real-time soft tissue torsion simulation in virtual surgeries,a torsion model based on coil spring is proposed to actualize real-time interactions and applications in virtual surgeries. The proposed model is composed of several connected coil springs in series. The sum of torsion deformation on every coil is equivalent to the soft tissue surface deformation. The calculation of the model is simple because the method for calculating the torsion deformation for each coil spring is the same. The virtual surgery simulation system is established on PHANTOM OMNI haptic device based on the Open GL 3 D graphic interface and VC + + software,and it is used to simulate the torsion deformation of virtual legs and arms. Experimental results show that the proposed model can effectively simulate the torsion deformation of soft tissue while being of real-time performance and simplicity,which can well meet requirements of virtual operation simulations.

Soft Tissue Deformation Model Based on Marquardt Algorithm and Enrichment Function

In order to solve the problem of high computing cost and low simulation accuracy caused by discontinuity of incision in traditional meshless model,this paper proposes a soft tissue deformation model based on the Marquardt algorithm and enrichment function.The model is based on the element-free Galerkin method,in which Kelvin viscoelastic model and adjustment function are integrated.Marquardt algorithm is applied to fit the relation between force and displacement caused by surface deformation,and the enrichment function is applied to deal with the discontinuity in the meshless method.To verify the validity of the model,the Sensable Phantom Omni force tactile interactive device is used to simulate the deformations of stomach and heart.Experimental results show that the proposed model improves the real-time performance and accuracy of soft tissue deformation simulation,which provides a new perspective for the application of the meshless method in virtual surgery.

Multidisciplinary treatment of soft tissue sarcomas:An update

Standard treatment for soft tissue sarcoma,based on complete surgical resection with or without adjuvant radiotherapy and chemotherapy,has not substantially changed during the last several decades.Nevertheless,recent advances have contributed to considerable improvement in the management of these patients;for example,new magnetic resonance imaging sequences such as diffusionweighted imaging and magnetic resonance imaging radiomics can better assess tumor extension and even estimate its grade.Detection of circulating genetic material(liquid biopsy)and next-generation sequencing are powerful techniques for genetic analysis,which will increase our understanding of the underlying molecular mechanisms and may reveal potential therapeutic targets.The role of chemotherapy in non-metastatic disease is still controversial,and there is a need to identify patients who really benefit from this treatment.Novel chemotherapeutic regimens have entered clinical praxis and can change the outcome of patients with metastatic disease.Advances in radiotherapy have helped decrease local adverse effects and sustain good local control of the disease.The following report provides an updated view of the diagnosis,treatment,and future perspectives on the management of patients with soft tissue sarcomas.

Magnetic resonance imaging of soft-tissue tumors of the extremities: A practical approach

Diagnosis of extremity soft-tissue tumors can be challenging.Characteristics of tumor margins can help precisely identify locally aggressive or non-aggressive behavior for surgical planning,but cannot differentiate benign from malignant lesions.Most malignant tumors can have inhomogeneous signals on T2-weighted images.Although a uniform signal on T2-weighted images can be a reliable indication of a benign lesion,a well-defined mass with homogeneous internal signal intensity does not definitively identify a benign lesion.Some common and distinctive soft-tissue lesions can have specific clinical and imaging features allowing a diagnosis without biopsy.These are known as determinate lesions.This illustrative report presents a diagnostic guide for extremity soft-tissue tumors based on tissue signal and morphological characteristics on magnetic resonance images.It is important for clinicians to be familiar with the imaging characteristics of common determinate lesions.

Experimental study on early repair of oromaxillofacial perforating soft tissue defect due to gunshot in dogs

The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the secondary debridement 72h alter in-jury.After the secondary thorough debridement,the cutaneous side of the defect was re-paired with a saphenous artery-vein free skin(muscular)flap using microvascularanastomosis,and the oral side of the defect was repaired by drawing the surroundingmucosa together and fixing with sutures or with a local sliding mucous membrane flap.All the animals were kept under observation for 2～6 months.It was believed that the pri-mary debridement and secondary thorough debridement were both essential. The survivalrate of the free tissue flap was 75%(6/8).These facts suggest that early repair ofthe oromaxillofacial perforating soft tissue defect due to gunshot is practicable.

A Soft Tissue Acupuncture Model Based on Mass-Spring Force Ne

In the simulation of acupuncture manipulation,it is necessary to accurately capture the information of acupuncture points and particles around them.Therefore,a soft tissue modeling method that can accurately track model particles is needed.In this paper,a soft tissue acupuncture model based on the mass-spring force net is designed.MSM is used as the auxiliary model and the SHF model is combined.SHF is used to establish a three-layer soft tissue model of skin,fat,and muscle,and a layer of the MSM based force network is covered on the surface of soft tissue to realize the complementary advantages and disadvantages of spherical harmonic function and MSM.In addition,a springback algorithm is designed to simulate the springback phenomenon of soft tissue skin during acupuncture.The evaluation results show that the soft tissue acupuncture modeling method based on mass-spring force net can effectively simulate the springback phenomenon of soft tissue surface during acupuncture surgery,and has good comprehensive performance in the application of virtual acupuncture surgery simulation.

Retrospective clinical analysis of MAID protocol as first-line treatment on 137 metastatic soft-tissue sarcomas patients

Objective:The aim of this study was to evaluate the efficacy,adverse reaction and survival of MAID protocol as first-line treatment on 137 metastatic soft tissue sarcomas patients.Methods:One hundredand thirty-seven patients with metastatic soft tissue sarcoma were given MAID protocol chemotherapy which consists of ifosfamide at a total dose of 8-10 g/m2 in 4-5 days,adriamycin at a dose of 60 mg/m2 on first day and dacarbazine at a dose of 200 mg/m2/d in 4-5 days.Twenty one days were regarded as a cycle and 2-6 cycles were completed.The median cycle number was 4.Results:Four cases had complete remission(CR)(2.9%),thirteen cases achieved partial remission(PR)(9.5%),eighty-eight cases maintained a stable disease(SD)(64.2%),and thirty-two cases had progressive disease(PD)(23.4%).The overall response rate(RR) was 12.4%,disease control rate(DCR) was 76.6%.The progression-free survival(PFS) was 2-14 months and median PFS was 5.00 ± 1.12 months.The overall survival(OS) was 3-19 months and median OS was 8.00 ± 1.32 months.Three months PFS rate was 56.9%,six months PFS rate was 27.2% and one year PFS rate was 7.8%.Three months OS rate was 100.0%,six months OS rate was 41.5% and one year OS rate was 10.7%.The main adverse reactions were bone marrow supression,nausea/vomiting and alopecia.Other adverse reactions were seldom observed.Conclusion:The effect of MAID protocol as first-line treatment on metastatic soft tissue sarcomas patients was exact,the treatment can control disease progression effectively and the side effects can be tolerable.It was obviously very worthy in clinical use as one of the first-line chemotherapy protocols on advanced soft tissue sarcomas.

A local high-resolution deformation model of soft tissue based on element-free Galerkin method

In order to solve the problem that the existing meshless models are of high computational complexity and are difficult to express the biomechanical characteristics of real soft tissue, a local high-resolution deformation model of soft tissue based on element-free Galerkin method is proposed. The proposed model applies an element-free Galerkin method to establish the model, and integrates Kelvin viscoelastic model and adjustment function to simulate nonlinear viscoelasticity of soft tissue. Meanwhile, a local high-resolution algorithm is applied to sample and render the deformed region of the model to reduce the computational complexity. To verify the effectiveness of the model,liver and brain tumor deformation simulation experiments are carried out. The experimental results show that compared with the existing meshless models, the proposed model well reflects the biomechanical characteristics of soft tissue, and is of high authenticity, which can provide better visual feedback to users while reducing computational cost.

Soft tissue aneurysmal bone cyst of the mandible:Report of a case

We report the case of a 17-year-old boy with a soft tissue aneurysmal bone cyst(STABC) located in the posterior aspect of the right mandible.Conventional radiography revealed no positive findings.On the computed tomography scan,the lesion appeared to have a nonuniform intralesional density.Magnetic resonance imaging revealed an abnormal soft tissue masses with cystic component in the superficial part of right mandibular body and angle with intact cortex.Following histopathological examination,fibro-histiocytic proliferation,blood-filled spaces and multinucleated giant cells were seen and the lesion was diagnosed as a STABC.The mass together with underlying bone and periosteum on its periphery was surgically resected under general anesthesia.Thirty-six months after surgery the patient was assessed at outpatient clinic and found no sign of recurrence This may be only the first reported case of the mandible in the English literature of this extremely rare benign tumor occurring in soft tissue.

The Importance of the Multidisciplinary Approach to Surgical Treatment of Extremity Soft-Tissue Sarcomas

Soft tissue sarcomas (STS) are rare neoplasm with frequencies around 1% of all neoplasms. Although it consists of a high heterogeneous group of tumors, surgery is the mean treatment. The STS surgery is still challenging and complex procedure is usually required: this is because STS requires different types of resection and reconstruction due to various tissue-commitments (nerve, arteries, skin and muscle). So, a multidisciplinary team must be prepared for STS approach to obtain the maximum local control and a limited extremity functional impairment. We, here, showing our experience, wish to introduce some technical contrivances in STS surgery, with special reference to tissue reconstruction. This may illustrate the necessity of a multidisciplinary team approach in this surgery.

First Reconstructive Plastic Surgery of the Perineum in a Hominin Pan paniscus (Bonobo) and Plea by a Plastic Surgeon for Surgery for the Benefit of All Hominins (Members of the Human Lineage)

We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sanctuary in Kinshasa in the Democratic Republic of the Congo was attacked by another bonobo. It was a large perineal wound through which urine flowed, located between the penis and the testicles, taking part of the anterior and posterior urethra, the bladder, as well as the elements of the spermatic duct. To repair the large loss of perineal substance, a pedicled flap of scrotal skin was removed, and then turned over, cutaneous surface on the trench of the loss of bladder substance and the urethral lumen. The postoperative course was satisfactory with healing by the first intention of the surgical wound, despite the wild postoperative behavior of the patient (removal of the vesicourethral catheter and protective plaster). We observed in the short term an urethro-cutaneous fistula, left in natural healing. The reconstructive surgery procedures applied in humans can also be applied with satisfactory results in bonobos, a species in the process of extension and whose members are our closest cousins. The bonobo is genetically close to humans. Based on this first successful experience, we advocate for reconstructive plastic surgery for all hominins (members of the human lineage), if indicated.

血管瘤样纤维组织细胞瘤14例临床病理学观察

目的探讨血管瘤样纤维组织细胞瘤(angiomatoid fibrous histiocytoma,AFH)的临床病理特征及分子学改变,分析其诊断、鉴别诊断及预后。方法收集14例AFH的临床、病理及随访资料,并文献复习。结果14例AFH患儿中,男童11例,女童3例;年龄11个月~12岁11个月,平均5.9岁。肿瘤位于四肢3例,躯干5例,头颈部5例,颅内1例。镜下肿瘤细胞核呈空泡状,合体样、漩涡状排列,可见纤维性假包膜及淋巴细胞鞘。9例可见假血管腔隙,2例可见钙化,2例核分裂活跃(活跃处11个/10 HPF)。3例镜下见硬化、黏液样间质。免疫表型:desmin(10/14)、EMA(12/14)、CD99(12/14)、SMA(9/12)、ALK(7/8)阳性,Ki67平均增殖指数16%。分子检测EWSR1基因断裂7例、EWSR1-ATF1融合2例、EWSR1-CREB1融合2例。14例患儿平均随访46个月,均无复发、转移。结论AFH是一种交界性或低度恶性肿瘤,儿童患者预后良好,很少复发或转移。诊断及鉴别诊断需要结合临床特点、组织形态、免疫组化及EWSR1、FUS基因检测综合分析。

3D氨基质子转移加权成像联合弥散加权成像鉴别良、恶性骨与软组织肿瘤

目的探讨3D氨基质子转移加权成像(APTWI)、弥散加权成像(DWI)及二者联合鉴别良、恶性骨与软组织肿瘤的价值。方法前瞻性对96例骨盆或下肢骨与软组织肿瘤患者采集平扫MRI、APTWI及DWI。分别基于APTWI及DWI获得偏移量为3.5 ppm的非对称性磁化传递率(MTRasym)图及表观弥散系数(ADC)图,测量病灶MTRasym(3.5 ppm)最大值(MTRasym_(max))、均值(MTRasym_(mean))及最小值(MTRasym_(min)),以及ADC最大值(ADC_(max))、均值(ADC_(mean))及最小值(ADC_(min));比较良、恶性肿瘤各参数差异,绘制受试者工作特征曲线,计算曲线下面积(AUC),评估APTWI、DWI及二者联合的鉴别诊断效能。结果96例中,良性41例、恶性55例。恶性肿瘤MTRasym(MTRasym_(max)、MTRasym_(mean)和MTRasym_(min))均明显高于,而ADC(ADC_(max)、ADC_(mean)和ADC_(min))均明显低于良性肿瘤(P均<0.05)。MTRasym_(max)和ADC_(min)鉴别良、恶性肿瘤的AUC分别为0.791和0.873,差异无统计学意义(P=0.122);二者联合的AUC为0.944,高于单一项(P<0.001、P=0.041)。结论APTWI联合DWI鉴别良、恶性骨与软组织肿瘤的效能较高。

基于混合拓扑填充球模型的子宫软组织形变模拟方法

软组织形变模拟是虚拟手术领域中最为重要的研究内容之一.对于子宫等具有复杂生理结构的人体器官而言,实现其形变建模并达到模拟的实时性要求是目前存在的挑战.为了解决上述问题,本文提出了一种具有混合拓扑结构的填充球形变理论,构建了面向子宫等复杂生理结构器官的形变建模方法,实现了子宫肌瘤剔除手术背景下的子宫形变模拟.首先,提出了改进的填充球模型,针对器官部位几何表面的差异性,不同于以往单一拓扑的连接方式,设计了包含四面体拓扑和依据中轴线拓扑的混合填充球结构,并综合考虑子宫生理特性与手术特点,进行了形变模型区域性与软组织特性的细节化设计.在此基础上,提出了一种基于度量张量剖分方法的四面体拓扑填充球结构的建模方法,结合中轴线的提取,分别建立了相应子宫部位的拓扑结构,从而构建出完整的子宫填充球模型.通过OpenGL编写了子宫形变的虚拟环境,并结合3D Systems公司的Touch力反馈设备搭建子宫形变模拟平台,实现了子宫软组织的模拟变形.最后,设计与开展验证实验,测试子宫形变模拟的效果及实时性;另一方面,搭建了一套测量真实软组织形变数据的实验平台,对本研究实现的虚拟形变与真实软组织形变进行对比.实验结果表明:虚拟子宫形变的画面刷新频率集中在40~60 Hz范围内,满足了手术训练的实时性要求;在软组织所受作用力小于3 N的情况下,两者形变位移的最大差异为0.117 mm,同时形变模拟效果符合真实软组织在外力作用下的整体变形趋势.

软组织重建治疗儿童蟹钳指畸形的方法研究

目的探讨软组织重建治疗儿童蟹钳指畸形的临床效果。方法2019年1月—2022年12月对25例蟹钳指畸形或蟹钳指畸形术后出现“Z”形畸形患儿进行软组织重建治疗,观察术后1年Tada评分、并发症发生情况。结果术后1年,25例患儿的Tada评分优16例(64%),良8例(32%),差1例(4%)。术后1年Peds QL评分(92.74±9.52)高于术前(79.25±7.43),比较差异有统计学意义(P<0.001)。指间关节伸直障碍、骨折愈合延迟各发生1例,并发症总发生率8%。结论软组织重建治疗儿童蟹钳指畸形,患儿无需经历一期切除重复拇指,二期行截骨矫形手术或者切除多指的多次手术,只需一次手术就完成蟹钳指截骨矫形,具有治疗周期短、患儿痛苦少、家庭经济成本低,且能显著提升患儿生存质量,临床效果满意等优点。

外阴巨大血管肌纤维母细胞瘤磁共振成像误诊为脂肪肉瘤一例

外阴血管肌纤维母细胞瘤(angiomyofibroblastoma,AMF)是一种育龄期女性罕见的良性肿瘤,起源于女性的外阴或阴道。脂肪肉瘤好发于围绝经期及绝经后女性的躯干、四肢等部位。报道1例外阴巨大AMF磁共振成像(magnetic resonance imaging,MRI)误诊为脂肪肉瘤的病例,该患者因发现外阴肿物3年,增大1年入院,术前MRI诊断为脂肪肉瘤,而术前活检诊断为AMF,行外阴肿物切除术+外阴成形术,术后病理检查诊断AMF,术后随访9个月未见复发。临床医生应加强疾病的鉴别诊断,通过结合术前组织病理学及其相关影像学检查可提高AMF的诊断准确率,为临床提供准确的手术指导信息。

多参数MRI影像组学与深度学习模型鉴别良、恶性黏液样软组织肿瘤

目的观察基于多参数MRI构建的影像组学与深度学习(DL)模型鉴别良、恶性黏液样软组织肿瘤(MSTT)的价值。方法回顾性纳入141例经病理证实的MSTT患者,以7∶3比例随机将其分为训练集(n=98,包括51例恶性及47例良性MSTT)及测试集(n=43,包括22例恶性及21例良性MSTT)。分别于训练集T1WI和脂肪抑制(FS)-T2WI中提取并遴选影像组学特征及DL特征,并以之构建鉴别良、恶性MSTT的影像组学模型及DL模型。绘制受试者工作特征(ROC)曲线、校准曲线及决策曲线,对比评估2个模型的区分度、校准度及净收益。结果于训练集提取并筛选得到9个最佳影像组学特征用于构建鉴别良、恶性MSTT的影像组学模型,包括2个一阶特征、1个形态特征、3个灰度共生矩阵特征、1个灰度相关矩阵特征和2个灰度大小区域矩阵特征;以其中7个最佳DL特征构建DL模型。所获影像组学模型和DL模型鉴别测试集良、恶性MSTT的ROC曲线下面积分别为0.758及0.911,后者高于前者(P=0.017);2个模型均具有良好校准度;相比影像组学模型,DL模型在测试集的总体净收益更高。结论基于MRI构建的DL模型鉴别良、恶性MSTT的效能较影像组学模型更好且净收益更高。

腰椎后路手术后病人软组织源性疼痛护理干预需求的质性研究

目的:评估腰椎后路手术后病人对软组织源性疼痛干预的需求,为病人术后软组织源性疼痛护理干预方案的构建提供依据。方法:采用目的抽样法选取2022年3月-10月在南通市第一人民医院脊柱外科住院符合标准的腰椎后路手术病人进行面对面半结构化访谈,采用Colaizzi现象学分析法进行资料分析。结果:总结导致腰椎后路手术病人术后软组织源性疼痛护理干预的障碍因素,归纳为躯体障碍因素、认知障碍因素、信息障碍因素及环境障碍因素4个主题及11个亚主题。结论:腰椎后路手术病人对术后软组织源性疼痛的认知及干预意识不足,缺乏系统、科学的疼痛护理干预方案,护理人员应结合腰椎后路手术病人术后软组织源性疼痛护理干预的障碍因素开展针对性护理,满足病人对疼痛干预的需求。