Otto T, Suhr J, Krege S, Rübben H
Westdeutsches Tumorzentrum, Essen.
Urologe A. 2003 Nov;42(11):1466-9. doi: 10.1007/s00120-003-0453-x.
Skin infiltration and locoregional lymph node extension in metastatic penile cancer leads to destruction in the inguinal and perineal region. Efficacy of systemic polychemotherapy based on cisplatin, methotrexate, and bleomycin (CMB scheme) is limited with an objective remission rate up to 30% only. The obligatorily superinfected defects require tension-free and extended coverage with immediate myocutaneous flaps after surgical resection. Pedicle flaps, consisting of skin, fascia, muscle, and the supplying vessels, are used to cover the post-resection defects. In the field of surgical uro-oncology the following myocutaneous flaps listed with the supplying vessels have proved themselves: M. tensor fasciae latae flap (A. circumflexa femoris lateralis), M. rectus abdominis flap (A. epigastrica inferior), M. gluteus maximus flap (A. glutea inferior). Data concerning a prospective study for neoadjuvant chemotherapy with CMB followed by surgical tumor resection with immediate myocutaneous flap reconstruction are presented. In 15 patients (median age: 69.7 years) suffering from squamous cell carcinoma of the penis (Tx, N3, M1 cutis), a surgical excision of the tumor was performed after neoadjuvant chemotherapy (median:2.4 cycles) and antibiotic pretreatment. All patients received coverage of the femoral vessels with a musculus sartorius transfer on both sides. An extended (up to 45x30 cm) tension-free coverage of groin defects was performed in two patients with a unilateral M. tensor fasciae latae flap (TFL) and in eight patients with a bilateral TFL. One patient received a M. gluteus maximus flap (GMFL) on both sides, three patients were treated with a combination of M. rectus abdominis flap (RFL) and TFL, and one patient received a combination of two TFL, one GMFL as well as one RFL. Of 31 myocutaneous pedicle flaps, 2 developed distant necrosis of the flap, in which one GMFL and one TFL were affected. No complete necrosis of the pedicle flap occurred. Primary wound healing was found in 29 of 31 myocutaneous flaps. The covering of groin defects by the use of myocutaneous flaps, such as the M. tensor fasciae latae, M. rectus abdominis, and M. gluteus maximus flap, is a method of first choice in the primary treatment of even bacterially contaminated wounds or after radiation therapy. The techniques of pedicle flaps are comparably applied in oncology and traumatology.
转移性阴茎癌的皮肤浸润和局部区域淋巴结扩散会导致腹股沟和会阴区域的破坏。基于顺铂、甲氨蝶呤和博来霉素的全身多药化疗（CMB方案）的疗效有限，客观缓解率仅高达30%。手术切除后，必然会发生感染的缺损需要用即时肌皮瓣进行无张力和广泛覆盖。带蒂皮瓣由皮肤、筋膜、肌肉和供应血管组成，用于覆盖切除后的缺损。在外科泌尿肿瘤学领域，以下列出的带供应血管的肌皮瓣已得到验证：阔筋膜张肌皮瓣（旋股外侧动脉）、腹直肌皮瓣（腹壁下动脉）、臀大肌皮瓣（臀下动脉）。本文介绍了一项关于CMB新辅助化疗后进行手术肿瘤切除并即时进行肌皮瓣重建的前瞻性研究的数据。15例阴茎鳞状细胞癌（Tx，N3，M1皮肤）患者（中位年龄：69.7岁）在新辅助化疗（中位：2.4个周期）和抗生素预处理后进行了肿瘤手术切除。所有患者双侧均采用缝匠肌转移覆盖股血管。2例患者采用单侧阔筋膜张肌皮瓣（TFL），8例患者采用双侧TFL对腹股沟缺损进行了广泛（达45×30 cm）无张力覆盖。1例患者双侧采用臀大肌皮瓣（GMFL），3例患者采用腹直肌皮瓣（RFL）和TFL联合治疗，1例患者采用2个TFL、1个GMFL和1个RFL联合治疗。在31个带蒂肌皮瓣中，2个出现皮瓣远处坏死，其中1个GMFL和1个TFL受影响。未发生带蒂皮瓣完全坏死。31个肌皮瓣中有29个实现一期伤口愈合。使用肌皮瓣，如阔筋膜张肌、腹直肌和臀大肌皮瓣覆盖腹股沟缺损，是原发性治疗即使是细菌污染伤口或放疗后伤口的首选方法。带蒂皮瓣技术在肿瘤学和创伤学中应用类似。
