Fibroma has the following types. A. yellow fibroma: it usually occurs in the dermis or subcutaneous layer near the trunk and upper arm, and often comes from small papules after trauma or itching. The lump is hard and the edge is unclear. Because of internal bleeding and hemosiderin, it is dark brown. If the tumor focus exceeds 1cm and grows rapidly, it should be suspected as fibrosarcoma, and the surgical resection must be complete. B. Dermatofibrosarcoma protuberans: located in the dermis, protruding from the body surface, with smooth surface skin and keloid appearance, prone to trunk, low-grade malignancy, pseudocapsule, easy to relapse after resection, and increased malignancy after repeated recurrence, which can be transferred through blood. Tumor lesions containing enough normal skin and deep adjacent fascia should be removed as soon as possible. C. Banded fibroma: Abdominal wall muscle is caused by reparative hyperplasia after trauma or birth injury, and there is no obvious capsule, so it is suitable for surgical resection.
Fibromatosis is a tumor derived from fibrous tissue. The incidence of benign soft tissue tumors was 1.37%. Tumors can occur in large muscles anywhere in the body, especially in the aponeurosis of rectus abdominis and its adjacent muscles, which are most common in pregnancy and late pregnancy. Outside the abdominal wall, it is more common in men, especially in shoulder blades, thighs and buttocks. The onset age is mostly between 30 and 50 years old, and it is not uncommon for children and adolescents. The etiology of this disease is not clear, which may be related to trauma, hormones and genetic factors.
Fibromatosis is a kind of fibrous tissue tumor which comes from muscle, aponeurosis and fascia and is rich in collagen. Pathologically benign or low-grade malignant. However, the tumor has no capsule, infiltrative growth and obvious malignant biological behavior, that is, repeated stubborn recurrence, but rarely distant metastasis. The recurrence rate is 25 ~ 57%. The recurrence time is mostly from 1 month to 1 year after operation, even more than 10 years, so this tumor is also called aggressive fibromatosis. Repeated recurrence can lead to the expansion of the lesion, uncontrolled growth, invasion of important organs and life-threatening.
Microscopically, the tumor is rich in collagen fibers, with no capsule and no boundary with surrounding tissues. Sometimes the surrounding tissues are included in the lesions, with little mitosis and few capillaries and fat cells. Morphological changes of fibrosarcoma can occur in a few recurrent cases.
The tumor is located in deep tissue with no obvious symptoms or slight discomfort. Slow growth. The shape is irregular or oval, and its long diameter is consistent with the direction of the involved muscle fibers. The size of the tumor is related to the duration of the disease, ranging from a few centimeters to more than ten centimeters in diameter. The periphery of the tumor is unclear, the surface is smooth, there is no tenderness and it is as tough as rubber. It is relatively fixed in the longitudinal direction of invading muscle, but it can move slightly in the transverse direction and does not adhere to the skin. Huge tumors can affect activities and compress nerves.
The tumor is small, mostly located in subcutaneous tissue, with slow growth, hard texture, bright surface, clear boundary, no adhesion with skin and certain activity. Mainly extensive surgical resection. Radiotherapy and hormone application can inhibit tumor growth in some cases, but it is generally considered that they can not be used as the main treatment, and can be used as palliative treatment for those who cannot operate.
Key points of operation: Although this disease has many malignant biological behaviors of recurrence, extensive and complete resection can prevent recurrence.
1. intraoperative frozen section examination most patients were diagnosed as this disease before operation, but the diagnosis was mainly made by intraoperative frozen section.
2. It must be widely removed, and the scope of removal should have a certain breadth and depth. It should include normal skin, muscles, tendons and other tissues with a depth of 3 ~ 5 cm around the tumor, as well as some normal tissues on its deep surface. If the tumor invades the periosteum or peritoneum, it should be removed together. If there are important blood vessels and nerves around the tumor, they should be separated sharply and blood vessels can be transplanted if necessary. Seriously grasp the indications of amputation and hemipelvic amputation.
We must master the treatment of tissue transplantation. Extensive tumor resection often leads to local soft tissue defects and exposure of important tissues, and tissue transplantation must be used to repair the local area. On the contrary, only by mastering the treatment method of tissue transplantation can we create conditions for radical surgery of tumors.
After extensive resection of fibromatosis, muscle defects or exposure of large blood vessels and nerves, bone joints and cartilage tissue defects often appear, and local myocutaneous flap or myocutaneous flap is the most ideal repair. Its advantages are: ① rich blood supply and easy survival. ② Simple operation. ③ Repair the defect immediately. ④ Strong anti-infectivity. (5) Rich tissues can be good padding and can play a buffering role. ⑥ The rotation radian is large, which is convenient for all-round transfer. If island myocutaneous flap is formed, it can reach180 DM; Transposition. This paper introduces the methods of repairing the defect of good site after operation with myocutaneous flap as follows:
1. After radical resection of hip joint mass, the sciatic nerve and ilium are often exposed, which requires thick tissue repair. The tensor fascia lata flap can be used for immediate transfer, and its nutrient vessel is the transverse branch of the lateral femoral circumflex artery, which enters the myocutaneous flap from the junction of the upper and middle muscles of 1/3. The aspect ratio of myocutaneous flap can reach 15× 35 ~ 40 cm, and the donor site is sutured in one stage.
2. After radical resection of the medial femoral mass, deep soft tissue defect or exposure of great vessels can also be repaired with tensor fascia lata muscle bone flap.
3. The gracilis myocutaneous flap can repair the lateral femoral mass after operation. Its vascular pedicle is a branch of medial femoral circumflex artery or deep femoral artery, which enters the flap from the upper part of muscle 1/3, and the aspect ratio is 6×24cm. The donor site is sutured in one stage.
4. After the resection of popliteal lump, popliteal artery and vein and popliteal spirit are often exposed, and sometimes there is a lump wrapping the vascular nerve bundle. If the nerves can be separated sharply and the blood vessels can be separated passively, the limbs can be preserved. The medial gastrocnemius myocutaneous flap can be used to transfer and fix the cross-legged posture. Its vascular pedicle is the medial sural vessel branched from the horizontal popliteal artery of the knee, which enters the muscle from the upper pole of the muscle, and the aspect ratio of the flap can reach 8×25cm. Skin grafting in donor site to eliminate wound.
5. Scapular mass is more common after resection, and it is repaired with lower trapezius island flap. Its nutrient vessel is the descending branch of the superficial branch of the transverse cervical artery, and the aspect ratio of the flap can reach 10× 15cm. Primary suture of donor site.
6. After abdominal tumor resection, the reticular fabric can be repaired with few skin defects and can be directly sutured; If there are too many defects, it can be repaired with the superficial island flap of the contralateral abdominal wall and wrapped with pressure.