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>> POSTNATAL SURGERY FOR SCT REQUIRES FAIRLY METICULOUS
DISSECTION TO REMOVE THE TUMOR.
>> FOR THOSE TUMORS THAT HAVE BOTH AN INTERNAL AND AN EXTERNAL
COMPONENT, IT MAY BE NECESSARY TO WORK BOTH IN THE ABDOMEN TO
CONTROL THE BLOOD SUPPLY TO THE LARGE VASCULAR TUMOR AS WELL AS
WORKING ON THE BOTTOM.
>> THE TUMOR CAN OFTEN BE MASSIVE.
IT USUALLY DISPLACES THE *** AND ***,
AND THAT'S SOMETHING THAT YOU HAVE TO BE VERY CAREFUL
TO PRESERVE, OBVIOUSLY.
IT ALSO DISPLACES THE NERVES AND BLOOD VESSELS AS THEY COME OUT
OF THE PELVIS.
AND SO YOU HAVE TO BE VERY CAREFUL BECAUSE THESE STRUCTURES
ARE DISPLACED AND THEY MAY NOT BE IN THEIR NORMAL POSITION,
TO METICULOUSLY STAY ON THE CAPSULE OF THE TUMOR AND FOLLOW
THE TUMOR INTO THE PELVIS AND UP TO ITS ORIGIN FROM THE COCCYX.
>> THE GOAL OF THE OPERATION IS TO REMOVE ALL OF THE TUMOR,
TO REMOVE THE TAILBONE BECAUSE THERE'S A RECURRENCE RISK IF THE
COCCYX IS NOT REMOVED BECAUSE THAT'S THE LOCATION WHERE
THE TUMOR ARISES FROM.
>> IT'S AS HIGH AS 30 PERCENT RECURRENCE RATE IF YOU DON'T
RESECT THE COCCYX.
AND SO WE RESECT THE COCCYX, WE REMOVE THE ENTIRE TUMOR
INCLUDING THE PELVIC COMPONENT, IF NECESSARY,
AND MOST OF THE TIME THAT WILL CURE THE BABY FROM THE SCT.
>> THEY'LL ALSO DO A RECONSTRUCTION OF THEIR BUTTOCKS
AREA AND HAVE A NICE SCAR FORMATION SO THAT YOU CAN
ACTUALLY TELL THAT IS THERE'S DEFINITION TO THEIR BOTTOM
LATER ON.
>> YOU'RE THINKING, "ARE THERE GOING TO BE ANY DEVELOPMENTAL
PROBLEMS?"
EVEN DOWN TO, YOU KNOW, IS SHE GOING TO FEEL BAD IN A BATHING
SUIT WHEN SHE GETS TO BE 14?
>> THE COSMETIC APPEARANCE OF SCTS IS SOMETHING THAT MAY NOT
BE OF GREAT CONCERN AT THE TIME, BUT IN THE LONG TERM FOR THE
CHILDREN AND THE FAMILIES, I THINK IT'S A VERY IMPORTANT
CONSIDERATION.
>> THE FIRST OBLIGATION WE HAVE AS PEDIATRIC SURGEONS IS TO
RESECT THE TUMOR COMPLETELY, DO AS COMPLETE OF A RECONSTRUCTION
AS POSSIBLE, AND THEN TO MAKE THINGS LOOK AS NORMAL AS
POSSIBLE, ALTHOUGH THAT CAN'T ALSO BE DONE IN ONE SETTING.
>> WHAT YOU NORMALLY TRY TO DO IS PRESERVE EVERYTHING THAT'S
BEEN DISTORTED BY THE TUMOR, PUT IT BACK TOGETHER IN AN ANATOMIC
WAY, AND MOST OF THE TIME YOU CAN HAVE A FAIRLY GOOD COSMETIC
APPEARANCE WITH THAT.
>> AND IT IS NECESSARY IN SOME CASES TO DO A SCAR REVISION FOR
VERY LARGE TUMORS, FOR INSTANCE.
>> THERE'S STILL A SCAR THERE.
THERE'S NO WAY TO DO THIS WITHOUT A SCAR,
BUT AT LEAST THE CONTOUR OF THE AREA LOOKS PRETTY NORMAL.