A 77-year-old male, with no toxic habits, with a history of allergy to contrast and urticaria, prostate adenocarcinoma with vertebral metastases in 1998, was treated with radiotherapy and chemotherapy.
Hypercholesterolaemia, hypercholesterolaemia, ischaemic heart disease, recurrent nephritic colic and intentional tremor.
A computed tomography (CT) scan of the prostate showed a right paraspinal mass.
Biopsy revealed the presence of a soft tissue myxoid sarcoma, 16 x 6 cm in diameter, extending from T12 to L3, without subcutaneous tissue involvement.
The patient was operated on by the Department of Traumatology and Orthopedics together with the Plastic Surgery Service, performing a block exeresis of the muscle compartment located in the affected spine.
The tumor did not affect microscopically the skin or subcutaneous tissue.
Preoperative imaging tests also suggested that the tumor respected superficial planes, so we chose to place a rectangular tissue expander, 20 x 7 cm in diameter, model SRV 750 crv 2007.
Closure was done by planes (subcutaneous cellular tissue and skin).
We tunneled the reservoir to fill the expander in a subcutaneous, cranial and lateral plane to its final location in the right midaxillary line.
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We performed intraoperative filling of the expander with saline until the skin was flat in relation to the adjacent regions, totaling 680 cc.
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Perioperative antibiotic prophylaxis was prescribed with intravenous cefuroxime, which was maintained for 5 days in the postoperative period, but had no incidents, except for postoperative anemia in the immediate phase requiring transfusion of 2 concentrates.
The hospital stay lasted 20 days, and the patient was able to walk on discharge independently, with corset support as the only orthopedic measure.
After the intervention, the Orthopedics Service performed periodic follow-up without lumbalgia, scoliosis, or neurological deficit in the first 10 months.
We also performed weekly follow-up visits in the plastic surgery outpatient clinic for up to 2 months after surgery, then once a month for 3 months, and then every 3 months thereafter.
We could check a good quality of the scar without significant functional deficits.
There was no expander extrusion, and imaging tests did not show any expander migration or volume depletion.
Control X-rays 4 months after surgery showed minimal right lumbar convexity, with no clinical repercussions, excellent functional recovery of the patient and good aesthetic result, without depression at the resection site.
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The pathological study reported the resected tumor specimen as sarcoma of the low-grade neural sheath, with incomplete resection at deep edge.
We decided, in a joint session at the Tumor Committee of our hospital, not to perform a surgical reintervention due to the patient's age and especially his general condition and previous pathologies.
We recommend follow-up periodical follow-up with MRI and serial CT.
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The patient was disease free for 9 months.
Since then, we detected local progression of the disease affecting the iliac psoas muscle and the lumbar square, and regional lymph node, with poor clinical tolerance to chemotherapy. Two years later, the patient died due to this process
