Nelson Jonas A, Fischer John P, Haddock Nicholas T, Mackay Duncan, Wink Jason D, Newman Andrew S, Levin L Scott, Kovach Stephen J
Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Reconstr Microsurg. 2016 Feb;32(2):101-8. doi: 10.1055/s-0035-1558986. Epub 2015 Aug 10.
Many patients with successful lower extremity salvage have postoperative functional and esthetic concerns. Such concerns range from contour irregularity preventing proper shoe-fitting to esthetic concerns involving color, contour, and texture match. The purpose of this study is to determine the overall incidence as well as factors associated with an increased likelihood of undergoing secondary, esthetic refinements of lower extremity free flaps and to review current revision techniques.
All patients undergoing lower extremity soft tissue coverage for limb salvage procedures between January 2007 and June 2013 at a single institution were included in the analysis. Patients who underwent secondary refinements for lower extremity free flaps were compared with patients not undergoing secondary procedures.
During the study period, 152 patients underwent reconstruction and were eligible for inclusion. Of these, 32 (21.1%) patients underwent secondary, esthetic revisions. Few differences in patient or case characteristics were noted, although revision patients trended toward being younger, having lower body mass index, with defects secondary to acute trauma located below the ankle. The most common revision was complex soft tissue rearrangement or surgical flap debulking/direct excision (87.5% of patients), followed by scar revision (12.5%), suction-assisted lipectomy (3.1%), laser scar revision (3.1%), and tissue expansion with local tissue rearrangement (3.1%).
A significant portion of patients desire secondary revisions following the initial procedure. This is especially true of younger patients with below ankle reconstruction. In many patients, an esthetic consideration should not be of secondary concern, but should be part of the ultimate reconstructive algorithm for lower extremity limb salvage.
许多成功保留下肢的患者术后存在功能和美观方面的问题。这些问题包括轮廓不规则导致鞋子穿着不合适，以及涉及颜色、轮廓和质地匹配的美观问题。本研究的目的是确定接受下肢游离皮瓣二次美学修复的总体发生率以及与之相关的增加可能性的因素，并回顾当前的修复技术。
纳入2007年1月至2013年6月在单一机构接受下肢软组织覆盖以进行肢体挽救手术的所有患者。将接受下肢游离皮瓣二次修复的患者与未接受二次手术的患者进行比较。
在研究期间，152例患者接受了重建手术并符合纳入标准。其中，32例（21.1%）患者接受了二次美学修复。患者或病例特征方面几乎没有差异，尽管接受修复的患者倾向于更年轻、体重指数更低，且踝关节以下急性创伤导致的缺损。最常见的修复是复杂的软组织重新排列或手术皮瓣减容/直接切除（87.5%的患者），其次是瘢痕修复（12.5%）、吸脂辅助抽脂术（3.1%）、激光瘢痕修复（3.1%）以及局部组织重新排列的组织扩张术（3.1%）。
很大一部分患者在初次手术后希望进行二次修复。对于踝关节以下重建的年轻患者尤其如此。在许多患者中，美学考虑不应是次要问题，而应成为下肢肢体挽救最终重建方案的一部分。
