Kang S, Han I, Kim S, Lee Y H, Kim M B, Kim H-S
Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Musculoskeletal Tumor Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea.
Department of Statistics, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 136-701, South Korea.
Eur J Surg Oncol. 2014 Sep;40(9):1101-8. doi: 10.1016/j.ejso.2014.05.004. Epub 2014 May 28.
Because of the complexity of flap reconstruction and the magnitude of soft tissue defects, patients undergoing flap reconstruction for extremity soft tissue sarcoma (STS) may have increased morbidity and poor outcome compared with those undergoing primary closure. However, to examine the accurate impact of flap reconstruction on extremity STS patients, the potential bias by confounding factors should be minimized.
We used propensity score analysis to match 37 patients who underwent flap reconstruction to 111 patients who underwent primary closure (1-3 ratio) based on patient and tumor characteristics at presentation. Treatment, functional, and oncologic outcomes were compared between the two groups.
Flap reconstruction group showed a lower Musculoskeletal Tumor Society functional score (P < 0.001), higher wound complication rate (P < 0.001), and longer hospital stay (P < 0.001); but had better local control (P = 0.015) than the primary closure group. Although failing to reach the statistical significance, the flap group tended to secure a wider surgical margin than the primary closure group (P = 0.051).
Patients who underwent flap reconstruction had increased morbidity associated with flap reconstruction, but better local control. These findings may have implications for treating extremity STS patients.
由于皮瓣重建的复杂性以及软组织缺损的程度，与接受一期缝合的患者相比，接受肢体软组织肉瘤（STS）皮瓣重建的患者可能发病率更高且预后较差。然而，为了准确评估皮瓣重建对肢体STS患者的影响，应尽量减少混杂因素造成的潜在偏倚。
我们采用倾向评分分析，根据患者就诊时的患者和肿瘤特征，将37例行皮瓣重建的患者与111例行一期缝合的患者（1:3比例）进行匹配。比较两组的治疗、功能和肿瘤学结局。
皮瓣重建组的肌肉骨骼肿瘤学会功能评分较低（P < 0.001），伤口并发症发生率较高（P < 0.001），住院时间较长（P < 0.001）；但与一期缝合组相比，局部控制情况更好（P = 0.015）。尽管未达到统计学意义，但皮瓣组获得的手术切缘往往比一期缝合组更宽（P = 0.051）。
接受皮瓣重建的患者因皮瓣重建而发病率增加，但局部控制情况更好。这些发现可能对肢体STS患者的治疗具有启示意义。
