Piper Merisa, Irwin Chetan, Sbitany Hani
Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
J Plast Reconstr Aesthet Surg. 2016 Jan;69(1):91-6. doi: 10.1016/j.bjps.2015.08.035. Epub 2015 Sep 5.
In recent years, dramatic advances in the multidisciplinary treatment of pediatric sarcoma have resulted in significant improvement in the long-term survival of the patient. Thus, following tumor resection, significant effort has gone into limb salvage and improving functional outcomes. Plastic surgeons, in conjunction with orthopedic surgeons, are using techniques in microvascular free-tissue transfer and rotational flap surgery to preserve limb length. This study presents a review of the current reconstructive strategies and the oncologic, surgical, and functional outcomes in this population.
Using the Pubmed and Cochrane Library databases, studies describing lower extremity plastic surgical reconstruction were identified following pediatric lower extremity sarcoma resection. This study included those studies which described reconstructive techniques, oncologic and functional outcomes, and surgical complications.
A total of nine articles were identified, yielding 96 pediatric patients. The most common procedures performed were free fibular flaps (53 patients) followed by pedicled muscle flaps (31 patients). A total of 72 of 96 patients (75%) achieved independent ambulation, and an additional 19 patients (20%) ambulated with assistance. There were only three (3%) amputations. A total of 13 patients died from metastatic disease (14%).
Plastic surgery procedures play an increasingly important role in pediatric lower extremity sarcoma reconstruction and functional limb salvage. Published series are limited in number and case volume; to date, no systematic review has been published. The existing data emphasize the role of microvascular free-fibula transfer as well as local muscle flap coverage in preserving limb length and function, with minimal risk of local recurrence and need for amputation.
近年来，小儿肉瘤多学科治疗取得了显著进展，患者的长期生存率有了显著提高。因此，在肿瘤切除后，人们付出了巨大努力来进行肢体挽救并改善功能预后。整形外科医生与骨科医生合作，正在使用微血管游离组织移植和旋转皮瓣手术技术来保留肢体长度。本研究对该人群目前的重建策略以及肿瘤学、手术和功能预后进行了综述。
利用PubMed和Cochrane图书馆数据库，检索小儿下肢肉瘤切除术后描述下肢整形外科重建的研究。本研究纳入了那些描述重建技术、肿瘤学和功能预后以及手术并发症的研究。
共检索到9篇文章，涉及96例儿科患者。最常进行的手术是游离腓骨瓣移植（53例患者），其次是带蒂肌瓣移植（31例患者）。96例患者中有72例（75%）实现了独立行走，另有19例患者（20%）在辅助下行走。仅3例（3%）进行了截肢。共有13例患者死于转移性疾病（14%）。
整形外科手术在小儿下肢肉瘤重建和功能性肢体挽救中发挥着越来越重要的作用。已发表的系列研究在数量和病例量上有限；迄今为止，尚未发表系统综述。现有数据强调了微血管游离腓骨移植以及局部肌瓣覆盖在保留肢体长度和功能方面的作用，局部复发风险和截肢需求最小。
