Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Ann Surg Oncol. 2017 Aug;24(8):2404-2412. doi: 10.1245/s10434-017-5876-5. Epub 2017 May 9.
Reconstruction of foot defects following oncologic resection is a crucial element in the treatment of soft tissue malignancy of the foot.
The present study aimed to comprehensively evaluate outcomes of oncologic foot reconstruction using free perforator flaps.
Outcomes of patients with soft tissue malignancy of the foot who underwent reconstruction using a free perforator flap following ablative surgery were reviewed, and perioperative and delayed complications (secondary debulking operation and flap instability) were documented. The Foot Function Index (FFI) questionnaire was surveyed to assess functional status.
Overall, 72 patients were analyzed, with a median follow-up period of 28 months. Malignant melanoma was a predominant etiology. Three kinds of perforator flaps were used, with the thoracodorsal artery perforator flap being the most common. Flaps with skin dimensions matching the defect size were inset and the thickness of the flaps was controlled with primary defatting. Flap re-exploration was conducted in 11 (15.2%) cases and total flap loss occurred in 3 (4.2%) cases. Delayed complications developed in an additional 12 cases, therefore 23 (31.9%) cases required a return to the operating room. The average FFI score was 8.86 at postoperative month 36, on average (range 11-128 months). All respondents reported being independently ambulatory and had minimal difficulty in their daily lives. Reconstruction of defects on weight-bearing regions showed a significantly higher FFI score than that on nonweight-bearing regions (mean 11.96 vs. 4.79, p = 0.029), although the scores remained very low for both instances.
Oncologic foot defects can be reliably reconstructed using well-contoured free perforator flaps with minimal functional morbidity.
足部肿瘤切除术后的缺损重建是足部软组织恶性肿瘤治疗的关键环节。
本研究旨在全面评估游离穿支皮瓣在足部恶性肿瘤重建中的疗效。
回顾性分析了足部软组织恶性肿瘤患者接受根治性切除术后，采用游离穿支皮瓣重建的临床资料，记录围手术期和迟发性并发症（二次减容术和皮瓣不稳定），并采用足功能指数（FFI）问卷评估患者的功能状态。
共纳入 72 例患者，中位随访时间为 28 个月。最常见的病因是恶性黑色素瘤。共使用了 3 种穿支皮瓣，其中以胸背动脉穿支皮瓣最常用。皮瓣大小与缺损相匹配，厚度通过初次去脂控制。11 例（15.2%）患者行皮瓣探查，3 例（4.2%）患者出现全皮瓣坏死。另外还有 12 例患者出现迟发性并发症，因此共有 23 例（31.9%）患者需要再次手术。术后 36 个月平均 FFI 评分为 8.86（11-128 个月）。所有患者均能独立行走，日常生活基本不受影响。负重区皮瓣的 FFI 评分明显高于非负重区（平均 11.96 比 4.79，p=0.029），但两者的评分仍然很低。
采用轮廓良好的游离穿支皮瓣可靠重建足部恶性肿瘤缺损，功能并发症少。
