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Ottenhof SR, Leone A, Djajadiningrat RS, Azizi M, Zargar K, Kidd LC, Diorio G, Mosiello G, Graafland NM, Spiess PE, Horenblas S. Surgical and Oncological Outcomes in Patients After Vascularised Flap Reconstruction for Locoregionally Advanced Penile Cancer. Eur Urol Focus 2019; 5:867-874. [DOI: 10.1016/j.euf.2018.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/13/2018] [Accepted: 02/01/2018] [Indexed: 11/24/2022]
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Leone A, Diorio GJ, Pettaway C, Master V, Spiess PE. Contemporary management of patients with penile cancer and lymph node metastasis. Nat Rev Urol 2017; 14:335-347. [PMID: 28401957 DOI: 10.1038/nrurol.2017.47] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Penile cancer is a rare disease that causes considerable physical and psychological patient morbidity, especially at advanced stages. Patients with low-stage nodal metastasis can achieve durable survival with surgery alone, but those with extensive locoregional metastasis have overall low survival. Contemporary management strategies for lymph node involvement in penile cancer aim to minimize the morbidity associated with traditional radical inguinal lymphadenectomy through appropriate risk stratification while optimizing oncological outcomes. Modified (or superficial) inguinal lymph node dissection and dynamic sentinel lymph node biopsy are diagnostic modalities that have been recommended in patients with high-risk primary penile tumours and nonpalpable inguinal lymph nodes. In addition, advances in minimally invasive and robot-assisted lymphadenectomy techniques are being investigated in patients with penile cancer and might further decrease lymphadenectomy-related adverse effects. The management of patients with advanced disease has evolved to include multimodal treatment with systemic chemotherapy before surgical intervention and can include adjuvant chemotherapy after pelvic lymphadenectomy. The role of radiotherapy in the neoadjuvant or adjuvant setting remains largely unclear, owing to a lack of high-level evidence of possible benefits. New targeted therapies have shown efficacy in squamous cell carcinomas of other sites and might also prove effective in patients with penile cancer.
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Affiliation(s)
- Andrew Leone
- H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA
| | - Gregory J Diorio
- H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA
| | - Curtis Pettaway
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit Number: 1373, Houston, Texas 77030, USA
| | - Viraj Master
- Emory University School of Medicine, 1365 Clifton Road NE, Building B, Room 1485, Atlanta, Georgia 30030, USA
| | - Philippe E Spiess
- H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA
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Verghese M, Hwang J. Specific Surgical Topics: A Multidisciplinary Management of Paratesticular Sarcomas in Adults. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
There is considerable literature on the potential for a femoral blowout in case of fungating inguinal lymph nodes in a case of penile carcinoma. However, reported cases of actual femoral blowout are sparse in literature. We encountered one such case of femoral blowout because of fungating inguinal lymph nodes in a case of Ca.Penis. Emergency palliative resection of the fungating nodes, ligation of the femoral vein, and emergency flap cover in the form of a perforator-based anterolateral thigh flap was performed. We believe that patients with a potential of femoral blowout should undergo resection and suitable coverage to prevent fatal hemorrhage.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India
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McGonigle KF, Amneus MW. Perioperative Issues in the Management of Vulvar Cancer. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ercole CE, Pow-Sang JM, Spiess PE. Update in the surgical principles and therapeutic outcomes of inguinal lymph node dissection for penile cancer. Urol Oncol 2011; 31:505-16. [PMID: 21481617 DOI: 10.1016/j.urolonc.2011.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 02/21/2011] [Accepted: 02/21/2011] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Inguinal lymph node dissection (ILND) for the treatment of metastatic penile squamous cell carcinoma (SCC) has historically been associated with significant morbidity. This review addresses the surgical principles and techniques to decrease its perioperative morbidity, while optimizing its oncologic outcomes. MATERIALS AND METHODS A review of the English scientific literature from 1966 to present was conducted using the PubMed search engine as well as of additional cited works not initially noted in the search using as keywords penile cancer, inguinal lymph node dissection, inguinal lymph node metastasis, morbidity, and complications. RESULTS The contemporary outcomes of ILND in the context of penile cancer have built on the significant contributions made by surgeons and scientists worldwide. In this review, we provide a comprehensive overview of the principles of ILND optimizing oncological outcomes, while minimizing its attributable morbidity. It is hoped this review will serve as a benchmark for clinicians to approach this often highly aggressive tumor phenotype. CONCLUSIONS ILND remains an important diagnostic and therapeutic procedure for patients with penile SCC, as contemporary ILND series have reported a decrease in its associated morbidity, with the potential for further treatment outcomes in years to come. ILND can in appropriately selected patients render them disease-free, thus justifying its associated morbidity.
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Affiliation(s)
- Cesar E Ercole
- Department of Genito-Urinary Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
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[Modified incomplete sartorius muscle flap for femoral vessel protection]. Chirurg 2011; 82:936, 939-41. [PMID: 21340588 DOI: 10.1007/s00104-010-2044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In exceptional cases bleeding of the femoral arteries after surgical interventions in the inguinal area can occur and in some cases can result in critical consequences with potential loss of limbs or fatal outcome. To prevent complications, especially after radical oncological surgery, a muscle flap is inserted to protect the vessel. In most cases the sartorius muscle is used because of its proximity to the operation area. This muscle also has the ideal size and a reliable and predictable position of nerves and vessels. The method of an incomplete sartorius muscle flap has considerable advantages in comparison with the complete method. The case presented is an example of modification of an incomplete sartorius muscle flap, which has been successfully applied in our clinic for extended inguinal dissection.
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Management of the Lymph Nodes in Penile Cancer. Urology 2010; 76:S43-57. [DOI: 10.1016/j.urology.2010.03.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/01/2010] [Accepted: 03/01/2010] [Indexed: 02/05/2023]
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Qi F, Zhang Y, Gu J. Repairs of complex groin wounds with contralateral rectus abdominis myocutaneous flaps. Microsurgery 2008; 29:199-204. [PMID: 19031396 DOI: 10.1002/micr.20593] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Management of complex groin wounds posterior to complications of vascular prosthetic surgery, malignant tumor excision, and irradiation therapy for recurrent cancers continued to pose a difficult task in reconstructive surgery. Pedicled and microsurgical myocutaneous flaps are valuable tools for wound repairs, but applications of these flaps are limited when the healthy vascular vessels are not available around the wound. In this report, we present our experience on the use of the contralateral rectus abdominis myocutaneous flaps for the coverage of the groin complex wounds in 13 patients. All the flaps were completely survived and the wounds healed uneventfully. The results suggest that the contralateral myocutaneous flap can be used for the repair of the groin wound with presence of significant comorbidities in the area, in which the ipsilateral local flaps and microsurgical flaps are not available.
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Affiliation(s)
- Fazhi Qi
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Trindade F, Rosa J. Vertical rectus abdominis myocutaneous flap in the treatment of a recurrent dermatofibrosarcoma protuberans. J Eur Acad Dermatol Venereol 2008; 23:75-6. [PMID: 18355204 DOI: 10.1111/j.1468-3083.2008.02672.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pedicled anterolateral thigh flap for reconstruction after radical groin dissection. Urology 2008; 70:996-9. [PMID: 18068461 DOI: 10.1016/j.urology.2007.07.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 06/21/2007] [Accepted: 07/18/2007] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Inguinal lymphadenectomy is performed for the treatment of nodal metastases from squamous cell carcinoma of the penis and other tumors of the trunk and lower extremity. Malignant skin infiltration requires wide resection, producing a defect requiring complex soft-tissue reconstruction. We have used a pedicled anterolateral thigh flap as our first-choice flap for these cases. We report a prospective series of cases using this recently described flap for reconstruction of groin defects after radical groin dissection. TECHNICAL CONSIDERATIONS From May 2001, 6 patients with locally advanced inguinal disease underwent wide skin excision and en bloc nodal resection with immediate reconstruction using a pedicled anterolateral thigh flap. Data were collected prospectively, and the data of 4 of 6 patients were reviewed at 6 months postoperatively. No flap losses occurred. Complete healing was achieved in all patients. The mean hospital stay was 18 days. The median time to complete healing was 33.5 days. The complications were seroma leading to flap congestion, wound dehiscence, wound infection, and delayed healing. The donor sites were either closed primarily or split skin grafted. CONCLUSIONS Reconstruction using a pedicled anterolateral thigh flap in patients with advanced inguinal nodal disease is a useful adjunct in selected patients. We present our indications for the procedure, our rational for the choosing this technique over other methods of reconstruction, and the difficulties we experienced.
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Kayes OJ, Durrant CA, Ralph D, Floyd D, Withey S, Minhas S. Vertical rectus abdominis flap reconstruction in patients with advanced penile squamous cell carcinoma. BJU Int 2007; 99:37-40. [PMID: 17227489 DOI: 10.1111/j.1464-410x.2007.06582.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the role of radical surgical debridement and excision with a vertical rectus abdominis myocutaneous (VRAM) flap reconstruction in patients with advanced penile cancer and subcutaneous metastatic disease, as the quality of life in such patients is extremely poor, multimodal treatments often fail and the outlook for the patient is limited with the development of uncontrollable disease. PATIENTS AND METHODS Four patients with advanced penile cancer presenting with fungating, cutaneous tumour deposits received palliative surgical resections for abdominal and inguinal disease. A VRAM flap was used in all cases to achieve tissue coverage. RESULTS All grafts were viable and the mean inpatient stay was 14 days. There were no immediate complications after surgery; patient satisfaction and symptom relief was excellent. CONCLUSIONS Aggressive palliative resection with a VRAM can dramatically improve the patients' quality of life in advanced penile cancer, permitting disease control with satisfactory cosmesis. However, a multidisciplinary approach involving both the urological reconstructive and plastic surgeon is essential.
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Affiliation(s)
- Oliver J Kayes
- Institute of Urology and Department of Plastic Surgery, Royal Free and University College Hospitals, London, UK
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Abstract
With minimal donor-site morbidity and bulky soft tissue supply, deep inferior epigastric perforator (DIEP) flap is now a preferred free flap in reconstructive surgery. Based on the experiences in free flap procedures, the authors explored a new usage of the DIEP flap to repair groin and scrotal defects. Over the last 2 years, 8 pedicled DIEP island flaps were successfully elevated and transferred in 7 male patients. With intramuscular dissection, the pedicle length could be elongated, with minimal damage to the abdominal fascia-muscular structure. Among these flaps, 5 were used for penoscrotal restore; 3 were raised to repair groin defects. All flaps survived completely. Groin reconstruction with such a flap gave a satisfactory esthetic result. Though somewhat bulky for penoscrotal restoration, it was acceptable for elderly patients. The authors conclude that this flap can be chosen as an alternative option to deal with complex groin and scrotal wounds.
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Affiliation(s)
- Ang Zeng
- Department of Plastic and Cosmetic Surgery, Peking Union Medical College Hospital, Beijing, China
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Wu LC, Djohan RS, Liu TS, Chao AH, Lohman RF, Song DH. Proximal Vascular Pedicle Preservation for Sartorius Muscle Flap Transposition. Plast Reconstr Surg 2006; 117:253-8. [PMID: 16404276 DOI: 10.1097/01.prs.0000185670.15531.50] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A variety of muscle flaps have been described to treat complex groin wounds associated with infected and/or exposed femoral vessels or vascular grafts and persistent lymphatic leaks, and for prophylaxis against wound breakdown following inguinal lymphadenectomy. The sartorius muscle flap has several advantages over other muscle flaps: it is immediately adjacent to the groin, it is easy to prepare, and the harvest causes no functional morbidity. Despite these advantages, the flap's reliability has been questioned because of the segmental blood supply to the muscle and the flap's limited arc of rotation. To improve the reliability of the flap, the authors defined the proximal vascular anatomy of the sartorius muscle in 20 human cadavers and assessed the correlation with 20 clinical cases. They describe a technique for the harvest of the sartorius muscle transposition flap that preserves the most proximal pedicle. METHODS From July of 2000 to January of 2004, 40 sartorius muscles were dissected in 20 human preserved cadavers. During the same time period, 21 sartorius muscle transposition flap procedures were performed in 19 patients for a variety of complex groin wound complications, including infection (n = 10), lymphadenectomy (n = 4), lymphatic leak (n = 3), exposed femoral vessels (n = 3), and high-risk wound (n = 1). The location of the most proximal vascular pedicle with respect to the anterior superior iliac spine was measured in each cadaveric dissection as well as in each clinical case. Outcomes were assessed in the clinical cases with respect to wound healing. RESULTS The distance between the anterior superior iliac spine and the proximal vessels in the cadaver specimens was 6.6 +/- 1.3 cm (range, 5.0 to 9.5 cm). The distance between the anterior superior iliac spine and the proximal vessels in the clinical patients was 6.2 +/- 0.6 cm (range, 5.5 to 7.5 cm). Patients were followed for an average period of 30 months (range, 5 to 45 months). There were no incidences of partial or total flap necrosis. All wounds healed to completion. CONCLUSIONS The proximal pedicle of the sartorius muscle is consistently located at 6.5 cm from the anterior superior iliac spine. Preservation of the proximal pedicle during dissection ensures the viability of the sartorius muscle transposition flap for the treatment of complex groin wounds.
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Affiliation(s)
- Liza C Wu
- Section of Plastic and Reconstructive Surgery, University of Chicago Hospitals, Chicago, IL 60637, USA
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Benoit L, Boichot C, Cheynel N, Arnould L, Chauffert B, Cuisenier J, Fraisse J. Preventing lymphedema and morbidity with an omentum flap after ilioinguinal lymph node dissection. Ann Surg Oncol 2005; 12:793-9. [PMID: 16132379 DOI: 10.1245/aso.2005.09.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 04/04/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pedicled omentoplasty has been advocated to prevent the formation of lymphocysts and lymphedema after pelvic lymph node dissection, We evaluated the possible benefit of a pediculated omentoplasty placed in the groin for preventing complications after ilioinguinal lymph node dissection. METHODS In this pilot study, we report a series of four women and three men with inguinal metastatic lymph nodes. Each was treated with a pediculated omentoplasty after groin dissection. We examined complications such as lymphedema, lymphorrhea, wound breakdown, skin necrosis, and lymphocysts. RESULTS Only one wound breakdown with skin necrosis was observed, and it healed satisfactorily in 10 days without exposing the femoral vessels. No lymphocele or infectious complications occurred, even though no antibiotic prophylaxis was used. Midthigh circumference increase ranged from 1.5 to 7 cm in four cases but remained asymptomatic. Furthermore, lymphedema of the lower limb decreased in the three remaining patients, who previously had an enlargement of the thigh. No evidence of peritoneal carcinomatosis was noted during the 4-month follow-up. CONCLUSIONS Pedicled omentoplasty seemed to facilitate the absorption or transport of lymph fluids and resulted in less lymphedema in the lower limb even after radiotherapy. Pedicled omentoplasty reduces both short-term and long-term postoperative complications without affecting treatment outcome and could even be considered as a safe and effective therapy for lymphedema of the lower extremity.
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Affiliation(s)
- Laurent Benoit
- Service de Chirurgie Digestive, Thoracique, et Cancérologique, CHU du Bocage, B.P. 77908, 21079, Dijon Cedex, France.
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Contemporary Morbidity From Lymphadenectomy For Penile Squamous Cell Carcinoma: The M.D. Anderson Cancer Center Experience. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65169-5] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Contemporary Morbidity From Lymphadenectomy For Penile Squamous Cell Carcinoma: The M.D. Anderson Cancer Center Experience. J Urol 2002. [DOI: 10.1097/00005392-200204000-00015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int 2001; 88:473-83. [PMID: 11589660 DOI: 10.1046/j.1464-410x.2001.00379.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S Horenblas
- Department of Urology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Affiliation(s)
- J J Elkabir
- Department of Urology, Chelsea and Westminster Hospital, London, UK
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Sevin BU, Abendstein B, Oldenburg WA, O'Connor M, Waldorf J, Klingler JP, Knudsen MJ. Limb sparing surgery for vulvar groin recurrence: a case report and review of the literature. Int J Gynecol Cancer 2001; 11:32-8. [PMID: 11285031 DOI: 10.1046/j.1525-1438.2001.011001032.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hemipelvectomy was successfully avoided in a patient with extensive necrotic groin recurrence of vulvar cancer after prior radiation therapy. Tumor-free resection margins were achieved by wide excision of the recurrence including resection of the pubic bone and adjacent muscles. After resection of the femoral artery, blood supply to the leg was restored by an extra-anatomic axillopopliteal bypass. A myocutaneous flap from the contralateral rectus abdominis was used for primary wound closure. Limb salvage was achieved and the patient experienced pain relief, excellent cosmesis, and independent gait. Aspects of treatment options, even though primarily palliative, in groin recurrence of vulvar carcinoma are discussed.
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Affiliation(s)
- B U Sevin
- Department of Obstetrics and Gynecology, Mayo Clinic, Jacksonville, Florida 32224, USA
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Reece GP, Gillis TA, Pollock RE. Lower extremity salvage after radical resection of malignant tumors in the groin and lower abdominal wall. J Am Coll Surg 1997. [DOI: 10.1016/s1072-7515(01)00926-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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