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Unformatted text preview: expansion of tumor-speciﬁc T lymphocytes in vivo, which was associated with a signiﬁcant clinical response.82 In a 2005 study, transfer of a T cell receptor gene from a 4 Malignant Skin Lesions — 9 patient with a signiﬁcant antitumor response conferred impressive T
Despite some advances in therapy, overall survival for patients
with stage IV melanoma has not improved over the past 20 years.
Overall 5-year survival remains lower than 5%, with a median survival of only 7.5 months.84 The best hope for future improvements
probably lies in the treatment of micrometastatic disease by means
of targeted chemotherapy and immunotherapy.
Operative Technique The inguinal nodes drain the anterior and inferior abdominal wall,
the perineum, the genitalia, the hips, the buttocks, and the thighs. A
superﬁcial groin dissection removes the inguinal nodes, whereas a
deep groin dissection incorporates the iliac and obturator nodes. Palpable nodes can be marked on the patient before operation.
SUPERFICIAL GROIN DISSECTION The patient is placed in a supine position on the operating table,
with the hip slightly abducted and with the hip and knee slightly
ﬂexed and supported by a pillow. A Foley catheter is inserted, and
the skin is prepared and draped.
The femoral artery, the anterior superior iliac spine, the pubic tubercle, and the apex of the femoral triangle are marked. A diagonally
oriented skin incision is made that extends from a point medial to MEDIAL DISSECTION Inguinal
Cord Pectineal Muscle Lymphatics
Specimen Long Adductor
Fascia Distal Portion of
Vein Ligated Figure 5 Superﬁcial groin dissection. The incision is deepened to
include the deep muscular fascia. © 2006 WebMD, Inc. All rights reserved. ACS Surgery: Principles and Practice 3 BREAST, SKIN, AND SOFT TISSUE
Retracted 4 Malignant Skin Lesions — 10 Lymphatics Continue under
Inguinal Ligament Medial to
Muscle LATERAL DISSECTION Nodal Tissue Fascia Femoral Sheath
Being Entered Fascia Branch of
Nerve Sartorius Muscle Figure 6 Superﬁcial groin dissection. The investing fascia overlying the femoral nerve and vessels is removed. the anterior superior iliac spine down to the apex of the femoral triangle; the incision is formed in the shape of an S so as not to cross
the thigh ﬂexion crease at a right angle. An incision oriented and
shaped in this manner will cause the least possible interference with
the musculocutaneous and cutaneous vascular territories of the skin,
will minimize ischemia to the skin ﬂaps, and will avoid a ﬂexion contracture. Flaps are raised to allow identiﬁcation of the medial border
of the sartorius, the lateral border of the adductor longus, and the external oblique fascia on the lower abdominal wall.
Fat and nodal tissue are swept inferiorly off the external oblique
aponeurosis, the spermatic cord, and the inguinal ligament [see Figure 5] and are reﬂected inferiorly.The fat and lymph nodes are then
dissected from the femoral triangle, sta...
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This note was uploaded on 03/21/2011 for the course ONC 01 taught by Professor Dzodic during the Spring '11 term at Multimedia University, Cyberjaya.
- Spring '11
- The Land