Langstein Howard N, Chang David W, Miller Michael J, Evans Gregory R D, Reece Gregory P, Kroll Stephen S, Robb Geoffrey L
Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4395, USA.
Plast Reconstr Surg. 2002 Jan;109(1):152-9. doi: 10.1097/00006534-200201000-00025.
Free flaps may safely allow meaningful ambulation, durable limb preservation, and better quality of life in patients undergoing resections of soft-tissue cancers of the foot. To prove this, the records of a series of patients at The University of Texas M. D. Anderson Cancer Center (n = 67) who underwent limb salvage following tumor-related resection (n = 71 procedures) from 1989 to 1999 were retrospectively reviewed. Eighteen patients who were not candidates for local flaps or skin grafts received a total of 20 free flaps to preserve their limbs. Most defects (mean size, 78 cm2; range, 20 to 150 cm2) were on a weight-bearing surface of the foot (nine on a weight-bearing heel, three on a plantar foot); the remainder were on a non-weight-bearing surface (six on dorsum, two on a non-weight-bearing heel). Melanoma was diagnosed in nine cases (50 percent); soft-tissue sarcoma, in seven (39 percent); and squamous cell carcinoma, in two (11 percent). Fasciocutaneous and skin-grafted muscle flaps were used on both weight-bearing and non-weight-bearing surfaces. Free-tissue transfer was successful in 17 of 20 cases (85 percent); the three flap losses occurred in two patients. Minor complications (i.e., small hematoma, partial skin graft loss, and delayed wound healing) occurred in five patients. In all cases of successful free-tissue transfer, patients began partial weight bearing at a mean of 7.4 weeks (range, 2 to 12 weeks), and all ultimately achieved full weight bearing. Sixty-seven percent still required special footwear. In one patient, an ulceration on the weight-bearing portion of the flap resolved after a footwear adjustment. Only one patient was lost to follow-up (mean, 23 months). In the 17 remaining patients, limb salvage succeeded in 15 (88 percent). Of these, nine (60 percent) were alive without evidence of disease, three (20 percent) were alive with disease, and three (20 percent) had died of disease. Local recurrence developed in two patients but was successfully treated by excision and closure. No late amputations were required for local control. Thus, it seems that free flaps help facilitate limb salvage and that they may preserve meaningful limb function in patients who undergo resection of soft-tissue malignancies of the foot.
对于接受足部软组织癌切除术的患者，游离皮瓣可安全地实现有意义的行走、持久的肢体保留以及更好的生活质量。为了证实这一点，我们回顾性分析了得克萨斯大学MD安德森癌症中心一系列患者（n = 67）的记录，这些患者在1989年至1999年间因肿瘤相关切除接受了保肢手术（n = 71例手术）。18例不适合采用局部皮瓣或皮肤移植的患者共接受了20例游离皮瓣以保留其肢体。大多数缺损（平均面积为78平方厘米；范围为20至150平方厘米）位于足部的负重表面（9例位于负重足跟，3例位于足底）；其余位于非负重表面（6例位于足背，2例位于非负重足跟）。9例（50%）诊断为黑色素瘤；7例（39%）为软组织肉瘤；2例（11%）为鳞状细胞癌。在负重和非负重表面均使用了筋膜皮瓣和带皮肤移植的肌皮瓣。20例中有17例（85%）游离组织移植成功；3例皮瓣坏死发生在2例患者身上。5例患者出现轻微并发症（即小血肿、部分皮肤移植失败和伤口愈合延迟）。在所有游离组织移植成功的病例中，患者平均在7.4周（范围为2至12周）开始部分负重，最终均实现了完全负重。67%的患者仍需要特殊鞋具。1例患者皮瓣负重部位的溃疡在调整鞋具后愈合。仅1例患者失访（平均23个月）。在其余17例患者中，15例（88%）保肢成功。其中，9例（60%）存活且无疾病证据，3例（20%）存活但有疾病，3例（20%）死于疾病。2例患者出现局部复发，但通过切除和缝合成功治疗。无需为局部控制而进行晚期截肢。因此，游离皮瓣似乎有助于促进保肢，并且可能保留接受足部软组织恶性肿瘤切除术患者的有意义的肢体功能。
