Treatment of MFH(Malignant fibrous histiocytoma) in Extremity.

Kang, Jong Hwa; Lee, Won Jai; Lew, Dae Hyun; Rah, Dong Kyun; Tark, Kwan Chul

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2008;35(4):439-445.
Published online July 1, 2008.

Treatment of MFH(Malignant fibrous histiocytoma) in Extremity.

Jong Hwa Kang, Won Jai Lee, Dae Hyun Lew, Dong Kyun Rah, Kwan Chul Tark

Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea. pswjlee@yuhs.ac

Abstract

PURPOSE
Malignant fibrous histiocytoma(MFH) is the most common soft tissue sarcoma in adult. As to this date, tissue development, treatment and prognosis of the tumor has not been definitely clarified, however, it has been reported that wide surgical resection of the tumor along with the radiotheraphy and chemotheraphy is needed for treatment. In MFH with high recurrence rate, the reconstruction method and points to be considered for reconstruction in recurrent case were studied in 10 patients who were treated in our hospital. METHODS: From August of 1991 to August 2007, location of tumor, initial mass size, 1st recurred period, lymph node metastasis, recurrence rate, treatment modality, complication, reconstruction in recurrent defect, and follow up period was studied in 10 patients who underwent reconstruction at our Plastic surgery department following wide excision.
RESULTS
The average age was 62.8(46-73) years old, average follow up period was 7.7(1-17) years. Various reconstructions has been performed for recurrent cases and postoperative chemotheraphy and radiotheraphy was done. As for reconstruction in recurrent cases, After wide excision, local flap was performed in 6 cases, and free flap in 2 cases. After radiotherapy, osteoradionecrosis was occurred in 4 cases. Recurrence rate was 1-5(2.6) times and reconstruction due to recurrence was 7 out of 10 cases(70%).
CONCLUSION
The treatment modality of MFH is not yet defined. Due to it's high recurrence rate, radiotherapy and chemotherapy is commonly combined with surgery. Even still, additional excision and reconstruction may be required. Therefore, possibility of re-operation must be considered when performing every excision and reconstruction; in case a recurrence or osteoradionecrosis occurs. Free flap coverage should be left as the last resort, according to the principle of reconstruction. Nevertheless, if the defect is large or osteoradionecrosis is present, it will benefit greatly to the patient's quality of life.

Keywords: MFH(Malignant fibrous histiocytoma); Recurred MFH; Reconstruction

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