Ng Zhi Yang, Ramachandran Savitha, Tan Bien-Keem, Foo Leon, Ng Siew-Weng
Singapore General Hospital, Singapore.
KK Women's and Children's Hospital, Singapore.
Hand (N Y). 2016 Mar;11(1):97-102. doi: 10.1177/1558944715614854. Epub 2016 Jan 14.
The goals of limb-sparing surgery in the setting of extremity malignancies are 2-fold: oncological clearance and the rehabilitation of function and aesthetics. Treatment success should be defined by the extent of restoration of the patient's premorbid function for reintegration into society.
We would like to report an unusual case of a patient with a chronically ankylosed elbow with joint invasion by basal cell carcinoma which resulted from malignant transformation of an overlying, long-standing wound due to inadequately treated septic arthritis from his childhood years.
Following R0 resection, upper limb shortening and compression plate elbow arthrodesis were performed with the aim of restoring the degree of upper limb function that the patient had been accustomed to preoperatively. The resultant circumferential defect was then closed with a contralateral, free muscle-sparing latissimus dorsi flap.
Functional preservation may therefore be more important than the mere restoration of anatomical defects in these especially challenging situations.
肢体恶性肿瘤保肢手术的目标有两个：肿瘤清除以及功能和美观的恢复。治疗成功应以患者病前功能恢复到何种程度以重新融入社会来定义。
我们想报告一例不寻常的病例，一名患者肘部长期强直且关节受基底细胞癌侵犯，这是由于其童年时期未得到充分治疗的化脓性关节炎导致的上肢长期伤口恶变所致。
在进行R0切除术后，进行了上肢缩短和加压钢板肘关节融合术，目的是恢复患者术前习惯的上肢功能程度。然后用对侧保留肌肉的背阔肌游离皮瓣封闭由此产生的环形缺损。
因此，在这些特别具有挑战性的情况下，功能保留可能比单纯修复解剖缺陷更重要。
