This article underscores what I believe is an important concept in the current state of the art of cancer therapy—namely that reconstructive plastic surgery is a key component in the treatment of many cancer patients. Clearly, the treatment of advanced-stage malignancies is now interdisciplinary, multimodal, and comprehensive. Chemotherapy and radiation therapy are becoming increasingly complementary modalities in the treatment of patients with more advanced disease.
I believe that the extent to which ablative surgery can be reasonably applied to cancer patients is determined, for the most part, by the ability to restore a good quality of life following such surgery. The primary means of accomplishing this restoration is through reconstructive surgery. As illustrated in the article by Hasen et al, plastic surgery plays a major role in the treatment of patients with breast cancer, and cancers of the head and neck, skin, trunk, and extremities, because it simultaneously restores both aesthetic appearance and meaningful function. More importantly, it permits the timely institution of adjuvant therapies within prescribed time intervals following surgery.
Surgical Advances
Tremendous advances have been made in the ability to transfer a patient’s own tissue from one area of the body to another. This is directly related to a remarkably detailed understanding of the macroscopic and microscopic vascular anatomy. These advances occurred in the mid- and late 1970s and early 1980s.
Detailed anatomic studies resulted in a renewed awareness of the relationship of the blood supply to the muscles of the body and its relationship to the blood supply of the overlying skin.[1] This led to the development of myocutaneous flaps, or composites of muscle with overlying skin, which could be transferred in a single stage from one area of the patient’s anatomy to another with more predictability and fewer complications than seen with the transfer of skin-only flaps.[2]
The second key development involved advances and refinements in the specialty of microsurgery, which resulted in the ability to disconnect composites of tissue (skin and muscle and skin and bone) from one anatomic location and reattach them in another by anastomosis of tiny blood vessels (between 0.5 and 2.0 mm in diameter), thus restoring blood flow in both the artery and vein of the transferred tissue composite. This ability represented a tremendous advance in the science of tissue autotransplantation or free-flap reconstruction.[3]
Together, these advances led to the introduction and refinement of many of the flap reconstruction techniques mentioned by the authors.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
