Engelhardt T O, Alghamdi H G, Wallmichrath J, Holzbach T, Dürr H R, Giunta R E
Handchirurgie, Plastische Chirurgie, Ästhetische Chirurgie.
Tumororthopädie der Klinik für Orthopädie, Klinikum der Ludwig-Maximilians Universität München.
Handchir Mikrochir Plast Chir. 2015 Apr;47(2):111-7. doi: 10.1055/s-0035-1545351. Epub 2015 Apr 21.
Limb-sparing surgery is considered as first choice in most patients with soft tissue sarcomas of the extremities. 5-year survival rates after limb soft tissue sarcoma resection have been promising in many specalised interdisciplinary centres. Quality of life as well as extremity function have thus become an integral aspect of the surgical management of soft tissue sarcomas of the extremities.
We herein report on our experience in the anatomic reconstruction of the extremities following limb-sparing soft tissue sarcoma resection using microvascular gracilis muscle flap and skin grafts.
Between 2012 and 2014 an anatomic reconstruction of the hand and foot using gracilis muscle flaps following limb-sparing sarcoma resection (leiomyosarcoma N=2, myxofibrosarcoma N=2, clear cell sarcoma N=1, myxoinflammatory fibroblastic sarcoma N=1, granular cell tumour N=1, pleomorphic sarcoma N=1) was performed in N=8 patients (4 females, 4 males), average age: 44 years (23-76 years), average follow-up time 444 days (98-820).
In all patients successful defect coverage with unimpaired wound healing was achieved (adjunctive radiotherapy n=4). The tendon of the harvested gracilis muscle was used for anatomic reconstruction of consequently resected essential anatomic structures (extensor retinaculum n=1, flexor/extensor tendons n=4, extensor expansion n=2, tendon reinsertion n=1, proximal interphalangeal joint collateral ligament n=4, dorsal metatarsal ligament n=1). During follow-up neither local recurrence nor metastasis was observed.
Reconstruction of multidirectional stability as well as restoring biomechanics and kinetics of the hand and foot should be considered during defect coverage and dead space obliteration management after sarcoma resection of the extremities. For reasons of sound options in anatomic extremity reconstruction with minimal donor site morbidity, the gracilis muscle flap excels in the field of limb-sparing sarcoma resection.
保肢手术被认为是大多数四肢软组织肉瘤患者的首选治疗方法。在许多专业的多学科中心，四肢软组织肉瘤切除术后的5年生存率一直很可观。因此，生活质量和肢体功能已成为四肢软组织肉瘤手术治疗中不可或缺的一部分。
本文报告我们使用股薄肌微血管皮瓣和皮肤移植对保肢软组织肉瘤切除术后的四肢进行解剖重建的经验。
2012年至2014年期间，对8例患者（4例女性，4例男性）进行了保肢肉瘤切除术后使用股薄肌皮瓣对手和足进行解剖重建（平滑肌肉瘤N = 2，黏液纤维肉瘤N = 2，透明细胞肉瘤N = 1，黏液炎性成纤维细胞肉瘤N = 1，颗粒细胞瘤N = 1，多形性肉瘤N = 1），平均年龄：44岁（23 - 76岁），平均随访时间444天（98 - 820天）。
所有患者均成功覆盖缺损，伤口愈合良好（4例接受辅助放疗）。所取股薄肌的肌腱用于对相应切除的重要解剖结构进行解剖重建（伸肌支持带n = 1，屈/伸肌腱n = 4，伸肌扩张部n = 2，肌腱再附着n = 1，近端指间关节侧副韧带n = 4，跖背韧带n = 1）。随访期间未观察到局部复发或转移。
在四肢肉瘤切除术后的缺损覆盖和死腔消除处理过程中，应考虑重建手和足的多向稳定性以及恢复其生物力学和动力学。由于在解剖学肢体重建中供区并发症最少且选择合理，股薄肌皮瓣在保肢肉瘤切除领域表现出色。
