Geller David S, Hornicek Francis J, Mankin Henry J, Raskin Kevin A
Orthopaedic Oncology Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Clin Orthop Relat Res. 2007 Jun;459:182-5. doi: 10.1097/BLO.0b013e3180514c50.
Limb-salvage surgery has become the standard of care for most soft tissue sarcomas. While primary closure is often possible, it is frequently complicated by wound-healing complications in the setting of previously irradiated tissue and surgical wounds closed under tension. We sought to identify a relationship between the volume of resected soft tissue and the rate of wound-healing complications. We retrospectively reviewed 108 patients who were treated over a 17-month period for soft-tissue sarcomas using limb-salvage methods. Of these, 87 patients were treated with primary wound closure and 21 patients underwent primary muscle flap closure at the time of wide surgical excision. Of the 87 patients treated with primary wound closure, the mean volume of resected tissue in the group with wound-healing complications was greater than that the group that healed without complications. The mean volume of resected tissue in the group with wound-healing complications was 919 cm3 +/- 1173 cm3 and the mean volume of resected tissue in the group without wound-healing complications was 456 cm3 +/- 704 cm3. Mean volume of resected tissue in the group of patients treated with primary flap coverage was 1908 cm3, over twice as large as the mean volume of resected tissue in the group of patients treated with primary closure.
保肢手术已成为大多数软组织肉瘤的标准治疗方法。虽然一期缝合通常可行,但在先前接受过放疗的组织以及在张力下闭合的手术伤口的情况下,伤口愈合并发症常常使其变得复杂。我们试图确定切除的软组织体积与伤口愈合并发症发生率之间的关系。我们回顾性分析了108例在17个月期间采用保肢方法治疗软组织肉瘤的患者。其中,87例患者进行了一期伤口闭合,21例患者在广泛手术切除时接受了一期肌皮瓣闭合。在87例行一期伤口闭合的患者中,发生伤口愈合并发症组的平均切除组织体积大于未发生并发症组。发生伤口愈合并发症组的平均切除组织体积为919 cm³±1173 cm³,未发生伤口愈合并发症组的平均切除组织体积为456 cm³±704 cm³。接受一期皮瓣覆盖治疗的患者组的平均切除组织体积为1908 cm³,是接受一期缝合治疗的患者组平均切除组织体积的两倍多。