Chapter 7 Hyperthermic Perfusion of Extremities for Melanoma and soft Tissue Sarcomas

y through a short oblique incision which divides the rectus muscle, and the tips of the catheters are passed to a point just distal to the inguinal ligament. An Esmarch bandage is employed as a tourniquet, being wrap~ed tightly around the upper portion of the thigh and held in this position by a steinmann pin driven into the anterior su~erior spine of the ilium. It is important that the major collateral vessels, i.e., deep circumflex iliac, inferior e~i­ gastric, and obturator vessels, be occluded or ligated to reduce leak­ age. For melanomas of the lower extremity which have metastasized to the femoral lymph nodes, perfusion at the femoral level is performed as a second-stage operation subsequent to iliac oerfusion. In such cases, femoral perfusion is immediately preceded by femoral lymphadenectomy. Because of its simplicity, femoral perfusion may also be employed as a primary procedure for melanomas of the lower extremity. A short verti~al incision is placed high in the femoral triangle. The saphenous vein is ligated and its stump is used to catherize the superficial femoral vein. The Esmarch bandage is applied as for iliac perfusion. If radical axillary dissection is not anticipated, the upper extremity is perfused via the axillary artery and vein. These vessels are ex­ posed through a short infraclavicular incision. The tips of the cathe­ ters are passed to the region of the upper third of the humerus and a proximal tourniquet is applied.