Chang Edward I, Nguyen Alexander T, Hughes Jennifer K, Moeller Julie, Zhang Hong, Crosby Melissa A, Skoracki Roman J, Chang David W, Lewis Valerae O, Hanasono Matthew M
Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
Department of Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2016 Mar;23(3):1036-43. doi: 10.1245/s10434-015-4905-5. Epub 2015 Oct 14.
A knowledge gap exists regarding factors to optimize limb salvage and function following oncologic resection.
We conducted a retrospective review of all free flaps performed for upper extremity (UE) and lower extremity (LE) salvage from 2000 to 2012.
Overall, 220 patients underwent free-flap reconstruction for limb salvage (UE: 64, and LE: 156). Flaps were classified as muscle-only (n = 77), myocutaneous (MC; n = 67), or fasciocutaneous (FC; n = 76). Smoking, diabetes, peripheral vascular disease, and prior chemotherapy or radiation had no impact on complications, while osteomyelitis significantly increased the risk of infection (odds ratio [OR] 19.5, confidence interval [95% CI] 3.77-100.64; p = 0.0004), wound healing complications (OR 7.51, 95% CI 2.21-25.49; p = 0.001), and amputation (OR 4.63, 95% CI 1.41-15.19; p = 0.01). Hardware increased the risk for flap loss (OR 4.92, 95% CI 1.33-18.23; p = 0.017). MC and FC flaps had increased risks for hematoma (p = 0.02) and reoperation for microvascular complications (p = 0.005) but were at lower risk for infection (OR 0.14, 95% CI 0.02-0.87; p = 0.03) compared with muscle-only flaps. There were a total of seven total flap losses (3.2%), with significantly increased risks for MC/FC flaps (OR 2.58, 95% CI 1.06-6.26; p = 0.03). For LE, 103 patients (66.3%) were fully ambulatory, while 23 (14.7%) were ambulatory with assistance (mean Musculoskeletal Tumor Society score (MSTS) 80.2, and Karnofsky score 84.0). For UE, 49 patients (76.6%) were able to perform their activities of daily living independently (mean MSTS 80.2, and Karnofsky score 86.0). Overall, 190 patients (86.4%) were successfully salvaged.
Free flaps can be performed reliably for limb salvage following tumor extirpation. While MC/FC flaps demonstrated improved postoperative function, they were at significantly higher risk for take-backs and total flap loss.
在肿瘤切除术后优化肢体挽救和功能的因素方面存在知识空白。
我们对2000年至2012年期间为挽救上肢（UE）和下肢（LE）而进行的所有游离皮瓣手术进行了回顾性研究。
总体而言，220例患者接受了游离皮瓣重建以挽救肢体（UE：64例，LE：156例）。皮瓣分为单纯肌肉皮瓣（n = 77）、肌皮瓣（MC；n = 67）或筋膜皮瓣（FC；n = 76）。吸烟、糖尿病、外周血管疾病以及先前的化疗或放疗对并发症无影响，而骨髓炎显著增加感染风险（优势比[OR] 19.5，置信区间[95% CI] 3.77 - 100.64；p = 0.0004）、伤口愈合并发症风险（OR 7.51，95% CI 2.21 - 25.49；p = 0.001）和截肢风险（OR 4.63，95% CI 1.41 - 15.19；p = 0.01）。内置物增加皮瓣丢失风险（OR 4.92，95% CI 1.33 - 18.23；p = 0.017）。MC皮瓣和FC皮瓣发生血肿的风险增加（p = 0.02）以及因微血管并发症再次手术的风险增加（p = 0.005），但与单纯肌肉皮瓣相比，感染风险较低（OR 0.14，95% CI 0.02 - 0.87；p = 0.03）。总共有7例皮瓣完全丢失（3.2%），MC/FC皮瓣的风险显著增加（OR 2.58，95% CI 1.06 - 6.26；p = 0.03）。对于LE，103例患者（66.3%）可完全行走，23例患者（14.7%）需借助辅助行走（肌肉骨骼肿瘤学会平均评分[MSTS] 80.2，卡诺夫斯基评分84.0）。对于UE，49例患者（76.6%）能够独立进行日常生活活动（平均MSTS 80.2，卡诺夫斯基评分86.0）。总体而言，190例患者（86.4%）成功挽救肢体。
游离皮瓣可可靠地用于肿瘤切除术后的肢体挽救。虽然MC/FC皮瓣术后功能有所改善，但回植和皮瓣完全丢失的风险显著更高。
