PREOPERATIVE DIAGNOSIS: Sarcoma right flank, metastatic.
POSTOPERATIVE DIAGNOSIS: Sarcoma right flank, metastatic.
1. Excision of mass, right flank.
2. Excision of left breast mass.
OPERATIVE INDICATIONS: This 85-year-old presents with sarcoma of the right flank with involvement of the left breast, left lung, and abdomen.
OPERATIVE PROCEDURE: Under satisfactory general anesthesia, the patient was placed in the left lateral decubitus position, and the right flank and axillary area were prepped with Betadine gel and draped in the routine fashion.
A transverse incision was made after injecting Marcaine 0.5% plain, and dissection was carried through the superficial fascia. The underlying mass, which was about 8 x 10 cm, was freed circumferentially with a cautery. A portion of the latissimus muscle was divided distally, and the entire mass was excised off of the underlying musculature. At one point there was a small amount of tumor within the lymphatics and vessels involving the blood supply to the latissimus. This was double clamped, divided, and ligated with 2-0 Vicryl. The entire mass was then swept off of the chest wall, excising a portion of the latissimus dorsi muscle with a cautery. The mass with excised and submitted to Pathology.
Bleeding points were controlled with a cautery and with a clamp and ligatures using 2-0 Vicryl ties. The subcutaneous tissue was irrigated with saline solution. The subcutaneous tissue was reapproximated with interrupted 3-0 Vicryl, and the skin was closed with staples using a #15 Blake drain in the wound prior to closure, which was secured to the skin with 3-0 silk.
The patient was then turned into the supine position, and the left breast was prepped with Betadine gel and draped in the routine fashion. A transverse incision made in the upper breast. Dissection carried through the subcutaneous tissue down to the underlying rather deep mass which was near the chest wall and was centrally located in the breast. The entire mass was excised from the surrounding fibrofatty breast tissue and submitted to Pathology for permanent sections.
Bleeding points were controlled with the cautery. A #15 Blake drain was placed into the central portion of the breast, brought out through the left lateral area, and secured to the skin with 3-0 silk. Sterile dressings were placed and held in place by a breast binder.
The patient, having tolerated the procedure well, was returned to recovery in satisfactory condition with vital signs stable.