Regenerating muscles after cancer surgery
Volume 9, Issue 3, December 2020
With oncoregeneration, the form and function of muscles can be restored after sarcoma surgery.
Matthew T. Houdek, M.D.
Steven L. Moran, M.D.
Advancements in microsurgery are making it possible to harness the body's healing power to regenerate muscle strength after surgery to remove soft tissue sarcoma. Mayo Clinic orthopedic oncologists are teaming up with plastic surgeons in a procedure they've coined "oncoregeneration."
The team is seeking to perfect this procedure in which large muscle is transferred to close a surgical wound and then coaxed to function like the muscle lost to cancer. In this oncoregenerative surgery, free muscle transfers are combined with pain management and lymphatic reconstruction. The goal is to restore function while preventing damage to nerves and lymph nodes, which can cause pain and swelling.
"Quality of life after surgery is one of the biggest reasons we started doing this surgery," said Matthew T. Houdek, M.D., an orthopedic oncologist at Mayo Clinic in Rochester, Minnesota. "With this functional transfer, we are attempting to restore form and function of the muscle." Patients with sarcoma often tire easily, mainly because they're relying on other muscle groups to restore the function that they once had. "Sometimes being just OK after cancer surgery isn't good enough," Dr. Houdek said.
Just a few decades ago, amputation was the only form of treatment. In more recent years, cancer could be controlled by removing only the tumor, but patients often developed severe limitations in mobility because of swelling, pain and loss of muscle.
The oncoregeneration procedure at Mayo Clinic is a free-flap surgery done under a microscope with high-precision tools smaller than the tip of a pen. These micro tools protect blood vessels, small nerves and small lymphatic vessels, which can be less than 1 millimeter in diameter, so that they can be transferred to the site of the tumor resection. Much like a plug placed in an electrical outlet, nerves and blood vessels from the healthy muscle are connected to the nerves and blood supply where the cancer was removed. That triggers a regeneration in which the transferred muscle may function like the one that was removed.
"Advancements in microsurgical techniques have made what we can repair and what we can restore much better," said Steven L. Moran, M.D., a plastic surgeon at Mayo Clinic in Rochester, Minnesota. "We now have the abilities to reconstruct and manage nerves in such a way that we minimize the chances of developing chronic phantom pain. We are also able to reconstruct the lymphatic channels to avoid painful fluid buildup and swelling that can limit mobility, also known as lymphedema. That's a major improvement for patients."