Murthy Vijayashree, Gopinath K S
Department of Surgical Oncology, Bangalore Institute of Oncology, Bangalore, India ; Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Rd., Livingston, NJ 07039 USA.
Indian J Surg Oncol. 2012 Jun;3(2):130-8. doi: 10.1007/s13193-012-0145-3. Epub 2012 Mar 28.
Inguinal lymph node involvement is an important prognostic and predictive factor in various neoplasms of the genitalia and lower limb. As part of the multimodality approach, these patients undergo surgery and adjuvant radiotherapy. Morbidity of inguinal lymphadenectomy includes lymphedema, lymphorrhea and infection; however the most common distressing complication is skin necrosis. Myocutaneous flaps have been the most popular form of primary or delayed groin reconstruction. This paper aims to critically review the different myocutaneous flaps used in groin reconstruction, discuss evidence based data on the versatility and utility of these flaps and discuss ways in which modifications maybe incorporated in treatment and radiation planning following groin reconstruction. A comprehensive search of the scientific literature was carried out using PubMed to access all publications related to groin reconstruction. The search focused specifically on current management, technique, safety and complications of these procedures. Keywords searched included "inguinal lymphadenectomy", "primary reconstruction", "musculocutaneus flap", "myocutaneous flap", "tensor fascia lata flap", "anterolateral thigh flap", "rectus abdominis flap". Low to middle income countries witness a huge burden of locally advanced genital malignancies and melanoma of the lower extremity. Higher tumor burden both at the primary site as well as the inguinal basin requires surgery as the primary modality of treatment. Groin reconstruction is required not only to prevent femoral blowouts but also for early administration of adjuvant radiation. The versatility of tensor fascia lata, anterolateral thigh, and rectus abdominis flaps is useful to cover the defect, provide radiation, eradicate pain and achieve good palliation. Assessment of aesthetic and functional outcomes of one flap over the other and the "ideal" form of reconstruction for groin defects needs additional investigation.
腹股沟淋巴结受累是生殖器和下肢各种肿瘤的重要预后和预测因素。作为多模式治疗方法的一部分，这些患者要接受手术和辅助放疗。腹股沟淋巴结清扫术的并发症包括淋巴水肿、淋巴漏和感染；然而，最常见且令人困扰的并发症是皮肤坏死。肌皮瓣一直是一期或延迟腹股沟重建中最常用的方式。本文旨在批判性地回顾用于腹股沟重建的不同肌皮瓣，讨论基于证据的数据以说明这些皮瓣的多功能性和实用性，并讨论在腹股沟重建后的治疗和放疗计划中可纳入哪些改良方法。利用PubMed对科学文献进行了全面检索，以获取所有与腹股沟重建相关的出版物。检索特别关注这些手术的当前管理、技术、安全性和并发症。检索的关键词包括“腹股沟淋巴结清扫术”“一期重建”“肌皮瓣”“张量筋膜阔肌皮瓣”“股前外侧皮瓣”“腹直肌皮瓣”。低收入和中等收入国家面临着局部晚期生殖器恶性肿瘤和下肢黑色素瘤的巨大负担。原发部位以及腹股沟区较高的肿瘤负荷需要将手术作为主要治疗方式。腹股沟重建不仅是为了防止股部破溃，也是为了尽早进行辅助放疗。张量筋膜阔肌皮瓣、股前外侧皮瓣和腹直肌皮瓣的多功能性有助于覆盖缺损、提供放疗、消除疼痛并实现良好的缓解效果。对一种皮瓣相对于另一种皮瓣的美学和功能结果进行评估，以及腹股沟缺损“理想”的重建形式，还需要进一步研究。
