Definition & Overview
The excision of fascial or subfascial soft tissue tumours is the procedure of surgically removing any abnormal growth in the fascia or subfascial part of muscles or soft tissues.
A fascia is a sheet of connective tissue that serves to provide enclosure to muscles and other internal organs. It also attaches these parts to body cavities. It is mostly composed of the protein called collagen, considered the most abundant protein in the human body. There are several types of fascia, classified according to their layer and location. The connective tissue surrounding muscles is called the deep fascia while those that wrap around internal organs and attach them to body cavities are called visceral fascia. There is also the superficial fascia, which is the connective tissue found underneath the skin and also surrounds blood vessels and nerves.
There are diverse types of soft tissue tumours and prompt diagnosis and management is important. Benign tumours may not prompt any immediate treatment though there are also cases in which a discovered abnormal growth may need to be surgically removed to avoid its spread.
Who Should Undergo and Expected Results
The excision of fascial and subfascial soft tissue tumours is carried out for the treatment of:
Fibromatosis – This is a benign tumour of the muscle fascia that grows quickly over time. It can be a source of great pain and discomfort, especially if it extends and presses into the underlying muscles. This condition occurs in all age groups and can grow in any part of the body.
Desmoid tumours - This is a type of fibromatosis that undergoes aggressive growth
Lipoma – This is a common type of tissue tumour that occurs within a muscle. When this condition occurs in other parts of the body, an excision is usually not indicated since this tumour is benign. However, it causes discomfort when this abnormal growth of fat cells is located within the muscle tissue. In this case, excision may be recommended so the patient avoids the pain it causes.
Excision of soft tissue tumors in fascia and subfascial levels provides relief from discomfort. Healing following the procedure takes about a week or two, depending on the location and depth of the tumour. Patients are usually asked to undergo physical therapy to encourage healing and restore function to muscles. If the affected part involves the use of lower limbs, the use of crutches may be required for a period of time.
In some cases of soft tissue tumour excision, the patient is asked to undergo radiation therapy following surgery. This typically involves tumours that are cancerous.
How is the Procedure Performed?
Prior to surgery, the surgeon collects images of the tumour to determine its features and location, which is used as a deciding factor if general or local anaesthesia is to be used. The surgical site is then marked, cleansed, and an incision is made on the skin surface where the tumour can easily be accessed.
There are several techniques employed in the excision of fascia or subfascial soft tissue tumours. One technique is intracapsular excision which involves taking out the tumour tissue piece by piece from the its pseudocapsule. As this technique is proven to have high recurrence rate, many surgeons only opt to use it during unusual circumstances.
When the pseudocapsule is excised along with the tumour inside it, the technique is termed marginal excision. This effectively removes the tumour along a marginal or little amount of tissue surrounding the tumour.
During wide excisions, the surgeon removes the tumour, its pseudocapsule, and a margin of healthy tissue surrounding it. The goal of this procedure is to decrease the chance of recurrence while sparing as much muscle tissue as possible. This means the excision is localised within the muscular compartment and not beyond it.
On the other hand, radical excision involves the removal of the entire muscle compartment where the tumour is located. Though there is a low to zero rate of recurrence in this procedure, it carries the greatest risk of losing muscular function.
Possible Risks and Complications
- Excessive bleeding during surgery
- Infection, which could set in right after, especially in non-sterile conditions
- Recurrence, especially if not all tumour cells were removed
- Injury to nearby nerves and blood vessels
- Compromised muscular function, though this complication can be addressed by physical rehabilitation
- Visible scarring, particularly for large-sized tumours
Potter DA, Glenn J, Kinsella T. Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol. 1985 Mar. 3(3):353-66.
Bland KI, McCoy DM, Kinard RE. Application of magnetic resonance imaging and computerized tomography as an adjunct to the surgical management of soft tissue sarcomas. Ann Surg. 1987 May. 205(5):473-81.