Complete guide to fibroid treatment methods

Fibroma is composed of well-differentiated subcutaneous connective tissue and is more common in adults aged 40-50. The tumor grows slowly and generally stops growing after developing to a certain extent. It is a benign tumor and rarely becomes malignant. Next, I will introduce a complete list of fibroid treatment methods, hoping it will be helpful to everyone.

Fibromatosis is a fibrous tissue tumor rich in collagen that originates from muscle, aponeurosis, and fascia. The pathological formation is benign or low-grade malignant. However, the tumor has no capsule and grows in an invasive manner. It has obvious malignant biological behavior, that is, it recurs stubbornly many times, but rarely metastasizes to distant places. The recurrence rate is 25% to 57%. The recurrence time is mostly 1 month to 1 year after surgery, and can even reach more than 10 years, so this type of tumor is also called invasive fibromatosis. Multiple recurrences can cause the lesions to spread more widely, and uncontrollable growth may occur, invading important organs and endangering life.

The tumor is located in deep tissues, with no obvious subjective symptoms or slight discomfort. It grows slowly. It is irregular or oval in shape, with its long diameter consistent with the direction of the affected muscle fibers. The size of the tumor is related to the duration of the disease, and the diameter ranges from several centimeters to more than ten centimeters. The tumor has unclear boundaries, a smooth surface, no tenderness, and is tough like rubber. It is relatively fixed longitudinally to the invaded muscle, but can move slightly laterally, and has no adhesion to the skin. Huge tumors can affect movement and compress nerves.

The tumor is not large, mostly located in the subcutaneous tissue, grows slowly, is hard, has a shiny surface, clear boundaries, no adhesion to the skin, and has a certain degree of mobility. It is mainly treated with extensive surgical resection. Radiotherapy and hormone application can inhibit tumor growth in individual cases, but it is generally considered not to be the main treatment method, but can be used as palliative treatment for those who cannot undergo surgery.

1. Key points of surgery: Although this disease has malignant biological behavior with multiple recurrences, extensive and thorough surgical resection can prevent recurrence.

1. Intraoperative frozen section examination Although most patients are diagnosed with this disease before surgery, the diagnosis is mainly confirmed based on intraoperative frozen sections.

2. Extensive resection is necessary. The resection must be wide and deep. It should include 3 to 5 cm of normal skin, muscle, tendon and other tissues around the tumor and certain normal tissues deep inside. If the tumor invades the periosteum or peritoneum, it should be removed together. If the tumor surrounds important blood vessels and nerves, it should be sharply separated and blood vessel transplantation can be performed if necessary. Severe cases should be controlled for indications of amputation and hemipelvic amputation.

3. It is necessary to master the treatment method of tissue transplantation. Extensive tumor resection often causes local soft tissue defects and exposure of important tissues, which must be repaired by tissue transplantation. Conversely, only by mastering the treatment method of tissue transplantation can we create conditions for radical cure of tumor surgery.

2. Repair method: After extensive resection of fibromatosis, there are often muscle defects or exposure of large blood vessels and nerves, exposed bones and joints, and cartilage tissue defects. Local myocutaneous flap or muscle flap repair is the most ideal. Its advantages are:

① Rich blood supply and easy to survive.

②Easy to operate.

③Repair the defect immediately.

④Strong anti-infection ability.

⑤The tissue is rich and can serve as a good pad and a buffer.

⑥ The rotation arc is large, which is convenient for transfer in all directions. If an island muscle flap is formed, the rotation can reach 180º.

The following are the methods for repairing the defect of the muscle flap after surgery:

1. After radical surgery for buttocks tumors, the sciatic nerve and iliac bone are often exposed, both of which require thicker tissue repair. Immediate transfer can be performed using the tensor fasciae lata myocutaneous flap, whose nutrient vessels are the transverse stripes of the lateral femoral circumflex artery, which enter the myocutaneous flap from the junction of the upper and middle 1/3 of the muscle. The length-to-width ratio of the myocutaneous flap can reach 15×35～40cm, and the donor site is sutured in the first stage.

2. After radical resection of the medial femoral mass, the tensor fasciae latae muscle-bone flap can also be used to repair deeper soft tissue defects or exposure of large blood vessels.

3. After surgery for the lateral femoral mass, the gracilis myocutaneous flap can be used for repair. Its vascular pedicle is a branch of the medial femoral circumflex artery or the deep femoral artery. The flap enters from the upper 1/3 of the muscle. The length-to-width ratio is 6×24cm, and the donor site is sutured in the first stage.

4. After the mass in the popliteal fossa is removed, the popliteal artery and vein and the popliteal nerve are often exposed, and sometimes the mass surrounds the blood vessel and nerve bundle. If the nerve can be sharply separated and the blood vessel can be bluntly separated, the limb can be preserved. The contralateral medial gastrocnemius head muscle flap can be used for transfer and fixed in a crossed-leg position. Its vascular pedicle is the medial gastrocnemius vessel branching off the popliteal artery at the level of the knee joint, which enters the muscle from the upper pole of the muscle. The length-to-width ratio of the flap can reach 8×25cm. Skin grafting is performed on the donor site to eliminate the wound.

5. Scapular region is more likely to occur in larger than teres muscle. After the tumor is removed, the lower trapezius muscle island flap is used for repair. Its nutrient vessel is the descending branch of the superficial branch of the transverse cervical artery. The length and width ratio of the flap can reach 10×15cm. The donor site is sutured in the first stage.

6. After the abdominal wall tumor is removed, the mesh fabric is used for repair. If the skin defect is small, it can be directly sutured. If the defect is large, the contralateral abdominal wall shallow island flap can be used for repair and pressure bandage.