Takeuchi Akihiko, Tsuchiya Hiroyuki, Shirai Toshiharu, Hayashi Katsuhiro, Nishida Hideji, Tomita Katsuro
Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Japan.
J Orthop Sci. 2009 Jul;14(4):385-90. doi: 10.1007/s00776-009-1353-8. Epub 2009 Aug 7.
Reconstructive surgery using pedicles or free muscle-skin flaps and skin grafting reduces wound complications and promotes favorable limb function; however, the sacrifice of normal tissue remains problematic and complicated. Occlusive dressings are widely employed for management of injuries, burns, and surgical wounds. However, their effectiveness for treating soft tissue defects following a soft tissue tumor excision has not been fully elucidated. The purpose of this study was to evaluate the effectiveness and safety of an occlusive dressing treatment method for soft tissue defects following soft tissue tumor excisions.
We retrospectively reviewed eight patients (three men, five women) whose wounds were treated with polyurethane foam occlusive dressings to allow reconstruction of the soft tissue defect following soft tissue tumor excision. Their mean age was 64.5 years (range 23-83 years), and the mean size of the defect was 60.1 cm(2) (range 20-144 cm(2)). The wound was covered with a hydrophilic polyurethane dressing material. The treatment periods, incidence of complications, and ultimate outcomes were evaluated.
Seven defects were completely healed by secondary intention without the requirement of any additional surgery. Mean treatment periods were 21.6 weeks (range 13.5-44.0 weeks). Mean follow-up periods were 33.1 months (range 15.8-48.6 months). One patient with a recurrent malignant fibrous histiocytoma (MFH) who had a history of radiotherapy required a posterior thigh flap 44 weeks after the surgery. Recurrence due to a positive surgical margin was observed in only one patient with recurrent MFH. None of the patients exhibited clinical evidence of superficial or deep infection.
This treatment method is simple, safe, and reliable. We concluded that the highly favorable indications of this treatment are ideal for patients who wish to avoid sacrificing their normal tissue, have no history of radiotherapy before surgery, and do not require chemotherapy or radiotherapy after the operation.
使用带蒂或游离肌皮瓣及植皮进行重建手术可减少伤口并发症并促进肢体功能良好恢复；然而，正常组织的牺牲仍然存在问题且较为复杂。封闭敷料被广泛用于治疗创伤、烧伤及手术伤口。然而，其在治疗软组织肿瘤切除术后软组织缺损方面的有效性尚未完全阐明。本研究的目的是评估封闭敷料治疗方法对软组织肿瘤切除术后软组织缺损的有效性和安全性。
我们回顾性分析了8例患者（3例男性，5例女性），其伤口采用聚氨酯泡沫封闭敷料治疗，以实现软组织肿瘤切除术后软组织缺损的重建。他们的平均年龄为64.5岁（范围23 - 83岁），缺损的平均面积为60.1平方厘米（范围20 - 144平方厘米）。伤口用亲水性聚氨酯敷料材料覆盖。评估治疗周期、并发症发生率及最终结果。
7处缺损通过二期愈合完全愈合，无需任何额外手术。平均治疗周期为21.6周（范围13.5 - 44.0周）。平均随访期为33.1个月（范围15.8 - 48.6个月）。1例有放疗史的复发性恶性纤维组织细胞瘤（MFH）患者在术后44周需要行大腿后侧皮瓣手术。仅1例复发性MFH患者因手术切缘阳性出现复发。所有患者均未表现出浅表或深部感染的临床证据。
这种治疗方法简单、安全且可靠。我们得出结论，该治疗方法的高度有利适应证对于希望避免牺牲正常组织、术前无放疗史且术后无需化疗或放疗的患者来说是理想的。
