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Blanco MD, de la Torre M, Lorca C, Del Cañizo A, Bada I, Monje S, García-Casillas MA, Villa Á, de Tomás E, Berenguer B. Use of pedicled flaps after oncologic resections in pediatric patients. Pediatr Surg Int 2024; 40:64. [PMID: 38433161 DOI: 10.1007/s00383-024-05654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
The aim of this study is to review the indications of pedicled flaps and analyze the results. A observational retrospective study of under 18-year-old oncology patients who required reconstructive surgery with pedicled flaps between 2011 and 2022 was performed. Demographic and clinical variables, indications, complications, and outcomes were collected. 236 patients were reviewed and 13 met inclusion criteria, eight girls and five boys (mean age: 10.6 years). Indications were Ewing's sarcoma (5), osteosarcoma (5), neuroblastoma, desmoid tumor, and neurofibroma. Preoperative PET-CT, MRI and bone scintigraphy were performed. The flaps were used on costal and extremity reconstruction: latissimus dorsi (5), pectoralis (2), medial gastrocnemius (2), combined latissimus dorsi, trapezius and serratus muscle, biceps femoris, fascio-neuro-cutaneous saphenous and cutaneous advancement-rotation. Two were performed on allograft and eight on prosthesis. All allowed immediate and complete closure. Six patients received intraoperative radiotherapy. One flap infection and two vascular complications were reported, a total necrosis, which required a new flap, and a partial necrosis, treated with a local plasty. Chemotherapy was resumed after 21 days (15-31). Mean follow-up time was 5.34 years. Flaps are an effective therapeutic option allowing reconstruction of large defects after pediatric oncologic surgeries. The most frequent complication was vascular.
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Affiliation(s)
- María Dolores Blanco
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Department of Pediatric Surgery, Hospital Materno Infantil Gregorio Marañón, C/O'Donnell, 48, 28009, Madrid, Spain.
| | - Manuel de la Torre
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Lorca
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Agustín Del Cañizo
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Bada
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Monje
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ángel Villa
- Pediatric Traumatology Department Hospital General, Universitario Gregorio Marañón, Madrid, Spain
| | - Elena de Tomás
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Beatriz Berenguer
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Bada Bosch I, Cañizo AD, Campos-Domínguez M, Ordoñez J, Blanco Verdú MD, Fanjul M, Pérez-Egido L, de Agustín JC. Juvenile Xanthogranuloma as Differential Diagnosis of a Vulvar Mass: A Case Report. European J Pediatr Surg Rep 2022; 10:e25-e29. [PMID: 35450098 PMCID: PMC9018129 DOI: 10.1055/s-0042-1743159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022] Open
Abstract
Vulvar masses in children are an unusual finding but their differential diagnosis is extensive. In case of solid masses, rhabdomyosarcoma (RMS) must always be considered due to the fact that it is the most common tumor in external genitals during childhood. However, RMS has a radiological appearance very similar to juvenile xanthogranuloma (JXG). We present a 16-month-old girl with a 2 cm solid mass on her left labia majora, with four overlying cutaneous papules. After imaging tests, an excisional biopsy was programmed due to high malignancy suspicion. Histopathology of the mass and one of the papules was diagnostic for JXG. After a 12-month follow-up, the patient shows no signs of relapse or complication. Deep JXG is an uncommon entity in childhood and exceptional in the genital area. Therefore, it must be included in the differential diagnosis of a solid vulvar mass, especially if accompanying yellowish xanthomatous cutaneous lesions are present.
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Affiliation(s)
- Isabel Bada Bosch
- Department of Pediatric Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Agustín Del Cañizo
- Department of Pediatric Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Minia Campos-Domínguez
- Department of Pediatric Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Ordoñez
- Department of Pediatric Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - María Fanjul
- Department of Pediatric Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Pérez-Egido
- Department of Pediatric Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos de Agustín
- Department of Pediatric Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Ordóñez J, Pérez-Egido L, García-Casillas MA, Del Cañizo A, Fanjul M, de la Torre M, Bada I, Blanco MD, Cerdá J, Molina E, Peláez D, de Agustín JC. Management and results of thyroidectomies in pediatric patients with MEN 2 syndrome. J Pediatr Surg 2021; 56:2058-2061. [PMID: 33814184 DOI: 10.1016/j.jpedsurg.2021.02.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
AIM OF THE STUDY To evaluate the outcome of prophylactic thyroidectomies (PT) in patients with MEN 2 syndrome in a tertiary center. METHODS A retrospective study was designed, including all patients with MEN 2 syndrome who underwent PT between 2000 and 2019. Demographics, gene mutation, postoperative complications and histopathological findings were registered. MAIN RESULTS 30 patients were included (29 MEN 2A and 1 MEN 2B) with a median age at surgery time of 7.0 ± 3.2 years. Familiar history was present in all but 3 patients. A therapeutic thyroidectomy was performed in 2 patients due to evidence of medullary thyroid carcinoma (MTC, both were late diagnosis), and in the other 28 cases, a PT was performed. 8 patients had a RET mutation ranked as Moderate Risk (American Thyroid Association): median age at surgery was 7.2 ± 4.2 years, and histological findings were C-cell hyperplasia (n = 6) and no alterations (n = 2). 16 patients had a high risk mutation; median age at surgery time was 6.9 ± 2.8 years and histological findings were normal thyroid gland (n = 1), C Cell Hyperplasia (n = 8), microcarcinoma (n = 6), and MTC (n = 1). The mean hospital stay was 1.4 ± 0.68 days. No intraoperative complications or recurrent laryngeal nerve injuries were registered. 7 patients presented a transient hypoparathyroidism and 1 patient had permanent hypoparathyroidism. CONCLUSIONS Early PT in patients with MEN 2 syndrome is a safe procedure when performed by an experienced team of Pediatric Surgeons and with a multidisciplinary approach. Early genetic analysis and familial counselling is essential to prevent the development of a MTC.
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Affiliation(s)
- Javier Ordóñez
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain.
| | - Laura Pérez-Egido
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
| | | | - Agustín Del Cañizo
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
| | - María Fanjul
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
| | - Manuel de la Torre
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
| | - Isabel Bada
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
| | - María Dolores Blanco
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
| | - Julio Cerdá
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
| | - Esther Molina
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
| | - David Peláez
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
| | - Juan Carlos de Agustín
- Department of Pediatric Surgery, Gregorio Marañón University Hospital Máiquez Street N 9, 28007 Madrid, Spain
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Ordóñez J, Del Cañizo A, Beléndez C, García-Morín M, Pérez-Egido L, Fanjul M, García-Casillas MA, Cerdá J, Peláez D, Bardón E, de Agustín JC, Cela E. Complications of Central Venous Access Devices in Patients With Sickle Cell Disease and Thalassemia Major. J Pediatr Hematol Oncol 2021; 43:e655-e660. [PMID: 33093353 DOI: 10.1097/mph.0000000000001972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/15/2020] [Indexed: 01/19/2023]
Abstract
Pediatric patients with sickle cell disease and thalassemia major present clinical characteristics that could lead to a higher incidence of central venous access devices-associated complications (CVAD-C). With the objective of analyzing the safety of the use of CVAD in these patients, a retrospective review including all pediatric patients with these pathologies who required the implantation of a CVAD between 2004 and 2019 was performed. In all, 54 patients with 100 CVAD (65 totally implantable venous access port with subcutaneous reservoir, 35 single-lumen or double-lumen partially tunneled catheter) were included. During 60,410 days at risk of suffering a CVAD-C, 55 complications (complication rate [CR]/1000 catheter-days at risk=0.91) were reported in 46 CVAD: 19 mechanicals (CR=0.32), 32 infectious (CR=0.53), and 4 thrombotic complications (CR=0.066). Incidence of mechanical and infectious complications was significantly higher in double-lumen partially tunneled catheter than in totally implantable venous access port with subcutaneous reservoir (P<0.001). Lower age at insertion was related with a higher incidence of any complication (odds ratio=0.88/y, P=0.02). Patients who required a stem cell transplantation (31 patients and 65 CVAD) had no significant higher incidences of CVAD-C. In conclusion, our study supports the safety of using CVAD in these patients, with a low incidence of infectious, thrombotic, and mechanical complications.
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Affiliation(s)
| | | | - Cristina Beléndez
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | - Marina García-Morín
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | | | | | | | - Eduardo Bardón
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Elena Cela
- Unit of Pediatric Oncology and Hematology, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
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