Bone and soft tumor department, He Nan Cancer Hospital, The Affiliated Hospital of Zheng Zhou University, 127 Dong Ming Road, Zheng Zhou City 450000, China.
World J Surg Oncol. 2013 May 23;11:110. doi: 10.1186/1477-7819-11-110.
While performing sacrectomy from a posterior approach enables the en bloc resection of sacral tumors, it can result in deep posterior peritoneal defects and postoperative complications. We investigated whether defect reconstruction with gluteus maximus (GLM) adipomuscular sliding flaps would improve patient outcomes.
Between February 2007 and February 2012, 48 sacrectomies were performed at He Nan Cancer Hospital, Zhengzhou City, China. We retrospectively examined the medical records of each patient to obtain the following information: demographic characteristics, tumor location and pathology, oncological resection, postoperative drainage and complications. Based on the date of the operation, patients were assigned to two groups on the basis of closure type: simple midline closure (group 1) or GLM adipomuscular sliding reconstruction (group 2).
We assessed 21 patients in group 1 and 27 in group 2. They did not differ with regards to gender, age, tumor location, pathology or size, or fixation methods. The mean time to last drainage was significantly longer in group 1 compared to group 2 (28.41 days (range 17-43 days) vs. 16.82 days (range 13-21 days, P < 0.05)) and the mean amount of fluid drained was higher (2,370 mL (range 2,000-4,000 mL) vs. 1,733 mL (range 1,500-2,800 mL)). The overall wound infection rate (eight (38.10%) vs. four (14.81%), P < 0.05) and dehiscence rate (four (19.05%)] vs. three (11.11%), P < 0.05) were significantly higher in group 1 than in group 2. The rate of wound margin necrosis was lower in group 1 than in group 2 (two (9.82%) vs. three (11.11%), P < 0.05).
The use of GLM adipomuscular sliding flaps for reconstruction after posterior sacrectomy can significantly reduce the risk of infection and improve outcomes.
从后路进行骶骨切除术能够整块切除骶骨肿瘤，但会导致深部后腹膜缺损和术后并发症。我们研究了使用臀大肌（GLM）脂肪肌滑动皮瓣进行缺损重建是否会改善患者的预后。
2007 年 2 月至 2012 年 2 月，在中国郑州市河南肿瘤医院进行了 48 例骶骨切除术。我们回顾性地检查了每位患者的病历，以获取以下信息：人口统计学特征、肿瘤位置和病理、肿瘤切除、术后引流和并发症。根据手术日期，我们根据闭合类型将患者分为两组：单纯中线闭合（组 1）或 GLM 脂肪肌滑动重建（组 2）。
我们评估了组 1 中的 21 例患者和组 2 中的 27 例患者。两组患者在性别、年龄、肿瘤位置、病理或大小或固定方法方面无差异。组 1 的最后引流时间明显长于组 2（28.41 天（范围 17-43 天）比 16.82 天（范围 13-21 天，P<0.05）），引流量也更高（2370 毫升（范围 2000-4000 毫升）比 1733 毫升（范围 1500-2800 毫升））。组 1 的总伤口感染率（8 例（38.10%）比 4 例（14.81%），P<0.05）和伤口裂开率（4 例（19.05%）比 3 例（11.11%），P<0.05）明显高于组 2。组 1 的伤口边缘坏死率低于组 2（2 例（9.82%）比 3 例（11.11%），P<0.05）。
后路骶骨切除后使用 GLM 脂肪肌滑动皮瓣重建可显著降低感染风险，改善预后。
