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diseaseFibrous Tumor Diseases
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bubble_chart Overview

Fibrous tumor diseases are tumors originating from fibrous tissue, accounting for 1.37% of benign soft tissue tumors. These tumors can occur in large muscles anywhere in the body, most commonly in the rectus abdominis muscle of the abdominal wall and its adjacent tendon membranes. They are particularly prevalent during pregnancy and the late stage of pregnancy (third trimester). Outside the abdominal wall, they are more common in men, frequently occurring in the scapular region, thighs, and buttocks. The onset age is typically between 30 and 50 years, but cases in children and adolescents are not uncommon. The exact cause of this condition remains unclear, but it may be related to trauma, hormonal factors, and genetic predisposition.

bubble_chart Pathological Changes

Fibrous tumor diseases are tumors originating from muscle, tendon membranes, and fascial membranes, rich in collagen components. Pathologically, they form as benign or low-grade malignant growths. However, the tumors lack a membrane and exhibit infiltrative growth, demonstrating clear malignant biological behavior, characterized by stubborn multiple recurrences but extremely rare distant metastasis. The recurrence rate ranges from 25% to 57%, with recurrence typically occurring within 1 month to 1 year post-surgery, and in some cases, even extending beyond 10 years. Hence, these tumors are also referred to as aggressive fibrous tumor diseases. Multiple recurrences can lead to increasingly widespread lesion involvement, resulting in uncontrollable growth that invades vital organs and endangers life.

Microscopically, the tumors contain abundant collagen fibers, lack a membrane, and show no clear boundaries with surrounding tissues. Sometimes, adjacent tissues are incorporated into the lesion. Mitotic figures are rare, and capillaries and fat cells are seldom observed. In a few recurrent cases, morphological changes resembling fibrous fleshy tumors may appear.

bubble_chart Clinical Manifestations

The tumor is located in deep tissues with no obvious subjective symptoms or only mild discomfort. It grows slowly and has an irregular or oval shape, with its long axis aligned with the direction of the affected muscle fibers. The size of the tumor is related to the duration of the disease, ranging from a few centimeters to over ten centimeters in diameter. The tumor has indistinct borders, a smooth surface, no tenderness, and a tough, rubbery consistency. It is relatively fixed along the longitudinal axis of the involved muscle but slightly mobile in the transverse direction and not adherent to the skin. Large tumors may impair movement or compress nerves.

bubble_chart Diagnosis

The tumor is usually small, mostly located within the subcutaneous tissue, grows slowly, is firm in texture, has a smooth surface, well-defined borders, no adhesion to the skin, and exhibits some degree of mobility.

bubble_chart Treatment Measures

The primary treatment is extensive surgical resection. Radiation therapy and hormone application may inhibit tumor growth in individual cases, but they are generally not considered as primary treatment methods and can serve as palliative measures for those who are ineligible for surgery.

(I) Key Points of Surgery Although this condition exhibits a malignant biological behavior with frequent recurrences, thorough and extensive surgical resection can prevent recurrence.

1. Intraoperative Frozen Section Examination While most patients are preoperatively diagnosed with this disease, confirmation primarily relies on intraoperative frozen section results.

2. Extensive Resection is Mandatory The resection must cover a sufficient breadth and depth, including 3–5 cm of normal skin around the tumor, as well as muscles, tendons, and a certain depth of underlying normal tissue. If the tumor invades the bone membrane or abdominal membrane, these should be excised as well. If the tumor envelops major blood vessels or nerves, sharp dissection should be performed, and vascular grafting may be necessary if required. Strict criteria should be followed for indications of amputation or hemipelvectomy.

3. Mastery of Tissue Transplantation Techniques Extensive tumor resection often results in local soft tissue defects and exposure of critical structures, necessitating tissue transplantation for reconstruction. Conversely, only by mastering tissue transplantation techniques can the conditions for radical tumor surgery be met.

(II) Repair Methods After extensive resection of fibrous tumor diseases, muscle defects or exposure of major blood vessels and nerves, as well as bone, joint, or cartilage defects, are common. Local myocutaneous or muscle flaps are the most ideal for repair. Their advantages include: ① Rich blood supply, ensuring high survival rates. ② Simple and straightforward procedure. ③ Immediate one-stage defect repair. ④ Strong resistance to infection. ⑤ Abundant tissue volume, providing excellent cushioning and shock absorption. ⑥ Large rotational arc, facilitating transfer in various directions; island myocutaneous flaps can achieve up to 180° transposition. The following outlines myocutaneous flap repair methods for defects post-resection in specific regions:

1. After radical resection of a gluteal mass, the sciatic nerve and iliac bone are often exposed, requiring thick tissue for repair. The tensor fasciae latae myocutaneous flap can be used for immediate transfer, with its nutrient vessels derived from the transverse branch of the lateral circumflex femoral artery, entering the flap at the junction of the upper and middle third of the muscle. The flap dimensions can reach 15×35–40 cm, and the donor site is closed primarily.

2. For deep soft tissue defects or major vessel exposure after radical resection of a medial thigh mass, the tensor fasciae latae osteomyocutaneous flap can also be employed.

3. After resection of a lateral thigh mass, the gracilis myocutaneous flap can be used. Its vascular pedicle is derived from branches of the medial circumflex femoral artery or deep femoral artery, entering the flap at the upper third of the muscle. The flap dimensions are 6×24 cm, and the donor site is closed primarily.

4. Following popliteal fossa mass excision, exposure of the popliteal artery, vein, and nerve is common. If the tumor envelops the neurovascular bundle, sharp dissection of the nerves and blunt dissection of the vessels may preserve the limb. The contralateral medial head of the gastrocnemius myocutaneous flap can be transferred, with cross-leg positioning for fixation. Its vascular pedicle is the medial sural artery, branching from the popliteal artery at the knee joint level and entering the muscle at its superior pole. The flap dimensions can reach 8×25 cm, and the donor site is covered with a skin graft.

5. For defects after resection of a teres major mass in the scapular region, the lower trapezius island flap is ideal. Its nutrient vessels are the descending branch of the superficial branch of the transverse cervical artery. The flap dimensions can reach 10×15 cm, and the donor site is closed primarily.

6. After abdominal wall tumor resection, mesh repair (using materials like Nylon, Teflon, Dacron, or Polyglactin) is performed. If the skin defect is small, direct closure is possible; for larger defects, the contralateral superficial abdominal island flap can be used for repair, followed by pressure dressing.

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