Bach Alexander D, Kopp Jürgen, Stark G Björn, Horch Raymund E
Department of Plastic and Hand Surgery, University of Erlangen, Erlangen Germany.
World J Surg Oncol. 2004 Jul 1;2:22. doi: 10.1186/1477-7819-2-22.
An understanding of the biology of bone and soft-tissue sarcomas, knowledge of adjuvant therapies and refinement in techniques of reconstructive surgery have allowed limb-sparing and limb salvage surgery to become a reality in the management of malignant tumors of the extremities. Functional limb salvage following radical resection has become a possibility in many resectable tumors by the use of alloplastic prostheses, homograft or autogenous bone for skeletal reconstitution combined with vascularized soft tissue coverage. Although the free fibula flap has been well described for reconstructions of the mandible and oral cavity, it has not been widely presented as an ideal tool to preserve extremities and to circumvent amputation.
We describe the complex surgical reconstruction in four patients with primary sarcomas of the extremities. The sarcomas (Ewing's sarcoma, osteosarcoma and epitheloid sarcoma) were resected radically and the massive bone and soft tissue defect was replaced by vascularized free fibula transfer.
We present our experience with versatility of this osteocutaneous flap to allow reconstruction and salvage of extremitity sarcomas. There were no operative or postoperative complication and all the four patients had good limb function. The flap was found to be versatile as it could be used for either upper limb or lower limb and for large defects. The results were better in upper limb than in lower limb.
Free fibular graft was found to be effective for salvaging limb function where a massive bone defect resulted from wide tumor resection in the extremities.
对骨与软组织肉瘤生物学特性的了解、辅助治疗知识以及重建手术技术的改进，使得保肢和肢体挽救手术成为治疗四肢恶性肿瘤的现实选择。通过使用异体假体、同种异体移植物或自体骨进行骨骼重建，并结合带血管的软组织覆盖，在许多可切除肿瘤中，根治性切除后保留功能肢体已成为可能。尽管游离腓骨瓣已被详细描述用于下颌骨和口腔的重建，但它尚未被广泛视为保留肢体和避免截肢的理想工具。
我们描述了4例四肢原发性肉瘤患者的复杂手术重建。对肉瘤（尤因肉瘤、骨肉瘤和上皮样肉瘤）进行根治性切除，并用带血管的游离腓骨转移修复巨大的骨和软组织缺损。
我们展示了这种骨皮瓣在重建和挽救肢体肉瘤方面的多功能性经验。无手术或术后并发症，所有4例患者肢体功能良好。发现该皮瓣具有多功能性，因为它可用于上肢或下肢以及大的缺损。上肢的结果优于下肢。
在四肢广泛肿瘤切除导致巨大骨缺损的情况下，游离腓骨移植被发现对挽救肢体功能有效。
