El-Gammal Tarek Abdalla, El-Sayed Amr, Kotb Mohamed Mostafa
Department of Orthopedics and Traumatology, Reconstructive Microsurgery Unit, Assiut University Hospitals and School of Medicine, Assiut 71516, Egypt.
Arch Orthop Trauma Surg. 2002 Apr;122(3):173-6. doi: 10.1007/s004020100348.
Stage IIB malignant tumors of the upper limb have been traditionally treated by amputation or disarticulation. There have been isolated reports on the technique of segmental resection of the tumor-bearing segment complete with the skin, and replanting the distal arm or forearm with or without neurovascular repair. The present paper describes four cases in which a wide resection margin was achieved in all by resecting the affected cylinder of the limb. Functional reconstruction was performed by appropriate tendon transfer. The main vessels and nerves were dealt with according to the findings revealed by preoperative investigations. If they had to be sacrificed, end-to-end suture was performed, but if the main nerves could be spared, it greatly enhanced the functional outcome. Local and systemic recurrences occurred in one case, and systemic recurrence occurred in another case. The other two cases remained disease-free at more than 4 years' follow-up. This operation is as radical as amputation, while the esthetic and functional results are equivalent to those of resection-arthrodesis.
上肢IIB期恶性肿瘤传统上采用截肢或关节离断术治疗。有个别报道称采用切除包含肿瘤节段的皮肤，并对远侧手臂或前臂进行再植，同时进行或不进行神经血管修复的技术。本文描述了4例病例，所有病例均通过切除肢体受影响的柱状结构实现了广泛的切除边缘。通过适当的肌腱转移进行功能重建。根据术前检查结果处理主要血管和神经。如果必须牺牲它们，则进行端端缝合，但如果主要神经可以保留，则大大提高了功能结果。1例发生局部和全身复发，另1例发生全身复发。另外2例在随访4年以上时无疾病复发。该手术与截肢一样彻底，而美学和功能结果与切除关节固定术相当。
