Tumor Surgery

Whenever I have been in a leading position at the different university clinics in Aachen, Zurich and Vienna I organized the integrative involvement of plastic surgery in the treatment of tumour patients. Besides participation in a lot of tumour boards I have built up an interdisciplinary center for treatment of haemangiomas and vascular malformations in Zurich as well as in Vienna.

Many malignant tumours of the soft tissue and bones are best treated by radical tumour resection (removal) in the healthy tissue. This often leaves large wounds in the soft tissue requiring immediate tissue replacement, and essential functional structures like blood vessels, nerves, muscles and joints often also need to be removed, which means that a useful and acceptable result is only achievable by way of a correspondingly differentiated reconstruction. The plastic surgeon therefore needs to be involved in the operative planning even before the tumour surgery is planned. This is the only way to ensure that the reconstructions making more sense at this primary stage are performed at the same time as the tumour resection, which will often only succeed if they are extensive enough to ensure that the wound can be closed again, anyway. If a secondary reconstruction is planned for a later date, including the plastic surgery in the overall planning of the treatment concept is crucial as well, because the options available for the later reconstruction also need to be highlighted right from the start, and will frequently influence the approach for the tumour surgery, too.

In the reconstruction of defects after tumour surgery, I personally not only attach particular importance to a successful closing of the wound, but also to considering all the options available for functional reconstruction at the same time. These principles particularly attain exceptional importance in the facial area. On the one hand, stigmatisation is especially grievous after tumour resection in the facial area because of the visibility, while very fine functions, e.g. those of the mimetic muscles, are on the other hand of vital importance here, but also particularly difficult to reconstruct. Whoever is performing the tumour surgery therefore not only needs to be familiar with gentle operation techniques, in order to do as little damage as possible, but is also required to know about all the possibilities of complex reconstruction if the result achieved is to be as optimal as possible in functional and aesthetic terms. The mastery of defect coverage is hence also an essential requirement for an unconditionally radical and oncologically appropriate resection of malignant tumours.