Surgery for ligamentoid fibroids

The origin of soft tissue tumors is complex and diverse, and can be divided into three categories: benign, intermediate and malignant. Surgical treatment of benign soft tissue tumors is relatively simple, and cure can be achieved by marginal resection. Intermediaries are characterized by invasiveness and are prone to recurrence after marginal resection. In the early stage, malignant soft tissue tumors are often characterized as painless masses. False capsules are often found during surgery and are easily mistaken for benign tumors. In recent years, the wide application of MRI has a good display effect on soft tissue tumors, and it is of great help to the preoperative diagnosis and surgical resection of soft tissue tumors. The surgical staging of soft tissue malignancies is generally based on the staging method of Enneking's bone and soft tissue tumors. For patients with short course of disease and obvious increase of soft tissue mass, malignant should be highly suspected, usually require biopsy, and then decide the treatment plan according to pathological diagnosis. Due to the large number of soft tissue tumors, this chapter only introduces several benign soft tissue tumors that are common in children and difficult to treat. Rigid fibroma is a locally invasive benign tumor that occurs mostly in deep soft tissues. It is more common in children. More men than women, occur in the buttocks, shoulders, back of the thighs, armpits, upper arms and forearms. The buttocks are the most common sites, usually characterized by deep painless masses. They usually have a history of several months or years at the time of the visit, often affecting the joint activities to attract attention. The lumps are unclear and have a hard texture that is fixed with the affected muscles. CT showed a uniform density of the mass and a higher CT value than the muscle. The main method of treatment is surgery. Surgical resection should be performed with extensive local excision. If marginal resection is used, it is easy to relapse after surgery. According to the author's experience, recurrence usually occurs within 1 year after surgery, and 2 years after surgery, there is little chance of recurrence. The gross specimen shows that the cross section of the tumor is white, tough, and the boundary between the surrounding muscles is unclear. Under the light microscope, the tumor is composed of a small amount of fibroblasts, fibroblasts and a large amount of collagen fibers. A small number of blood vessels can be seen, and the tumor tissue infiltrates into the surrounding normal tissue. Treatment of diseases: benign tumor soft tissue tumors Indication Once a hard fibroma is diagnosed, it should be treated as soon as possible. Preoperative preparation 1. Carefully check the size of the mass and record the extent of joint activity. 2. CT or MRI examination to understand the size of the tumor and the relationship with the surrounding organs in order to determine the extent of resection. Surgical procedure Incision The surgery uses a longitudinal incision on the surface of the tumor. 2. Reveal The skin and subcutaneous tissue were cut along the direction of the incision, exposed between the deep and shallow fascia, and the flap was pulled to the sides. If the tumor involves nerves and blood vessels, it should be dissected and then resected. 3. Tumor resection After the nerves and blood vessels are dissected, about 2 to 5 cm at the upper and lower boundaries of the tumor, the normal surrounding muscles are cut, and the bone tissue is involved, and the periosteum is removed together until the cortical bone is exposed. 4. Close the incision The wound was hemostatically treated with hot saline gauze and further electrocoagulated to stop bleeding. After washing with saline, the remaining muscle stumps were sutured. If the broken ends on both sides are too short, they can be fixed together with the surrounding muscles. The incision is provided with a vacuum suction tube, and the incision is sutured intermittently.