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Plastic Surgery: A Component in the Comprehensive Care of Cancer Patients

Plastic Surgery: A Component in the Comprehensive Care of Cancer Patients

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.

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