Sahijwani Harshvardhan, Warikoo Vikas, Salunke Abhijeet Ashok, Shah Jaymin, Bhavsar Preetish, Wagh Rahul, Pathak Subodh
Plastic Surgeon, Divine Plastic and Cosmetic Surgery Centre, Ahemdabad, Gujarat, India.
Department of Oncosurgery, Gujarat Cancer Research Institute, Ahemdabad, Gujarat, India.
Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):342-347. doi: 10.4103/apjon.apjon_32_17.
Posttumor excision defects can be very large, and many do require postoperative radiotherapy. It is therefore important to provide stable and durable wound coverage to provide ability to withstand radiotherapy as well as providing cover to vital structures.
Between July 2014 and June 2016, eight females and six male patients with defects around the knee were operated upon using a perforator plus flap from the anterior tibial artery perforator. In all except two patients, the defects were the result of posttumor extirpation, while in the latter, it was due to impending implant exposure following bone tumor excision and tibial prosthesis. A constant perforator at the neck of the fibula was found using hand-held Doppler. The base of the flap was always kept intact. The flap was then transposed toward the defect and inset in a tensionless manner.
The average flap dimension was 14 cm × 5.5 cm. The mean follow-up was 11 months (6-20 months). All the flaps survived well except in one patient who developed partial tip necrosis, providing stable coverage of the wound. Two patients developed local recurrence and had to undergo above-knee amputation.
The planning for the reconstruction of defects following tumor resection is to be done in accordance with a multidisciplinary team approach involving oncosurgeon, reconstructive plastic surgeons, and radiation specialist. The perforator plus flap is an excellent choice in defects around the knee to cover neurovascular structures, bone, or implant.
肿瘤切除后的缺损可能非常大，许多确实需要术后放疗。因此，提供稳定而持久的伤口覆盖以具备耐受放疗的能力以及为重要结构提供覆盖非常重要。
在2014年7月至2016年6月期间，对8名女性和6名男性膝关节周围有缺损的患者使用来自胫前动脉穿支的穿支加皮瓣进行手术。除2名患者外，所有缺损均为肿瘤切除后所致，而在后者中，是由于骨肿瘤切除和胫骨假体植入后即将发生的植入物外露。使用手持式多普勒在腓骨颈处发现恒定的穿支。皮瓣的基部始终保持完整。然后将皮瓣转移至缺损处并以无张力的方式嵌入。
皮瓣平均尺寸为14 cm×5.5 cm。平均随访时间为11个月（6 - 20个月）。除1例患者出现部分皮瓣尖端坏死外，所有皮瓣均存活良好，为伤口提供了稳定的覆盖。2例患者出现局部复发，不得不接受膝上截肢。
肿瘤切除后缺损重建的规划应按照多学科团队方法进行，该团队包括肿瘤外科医生、整形重建外科医生和放疗专家。穿支加皮瓣是覆盖膝关节周围缺损处神经血管结构、骨骼或植入物的极佳选择。
