Stranix John T, Lee Z-Hye, Lam Gretl, Mirrer Joshua, Rapp Timothy, Saadeh Pierre B
Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY.
Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY.
Microsurgery. 2018 Jul;38(5):466-472. doi: 10.1002/micr.30254. Epub 2017 Oct 9.
Innervated muscle transfer can improve functional outcomes after extensive limb-sparing sarcoma resections. We report our experience using composite thigh flaps for functional reconstruction of large oncologic extremity defects.
Between 2011 and 2014, four limb-sparing oncologic resections (3 lower extremities, 1 upper extremity) underwent immediate functional reconstruction with composite thigh free flaps in three males and one female. The age of the patients ranged from 36 to 73 years. There were 3 soft-tissue sarcomas and one giant cell tumor, all required resection of entire muscle compartments. Flap components included fasciocutaneous tissue with sensory nerve, plicated iliotibial band (ITB), and variable amounts of motorized vastus lateralis (VL).
All flaps survived without complications. All patients showed VL motor innervation by six months. Follow-up ranged from 20 to 36 months. Motor strength ranged from 2 to 5 out of 5, active range of motion was 25-92% of normal, and Musculoskeletal Tumor Society (MSTS) Scores were between 22 and 29 out of 30.
Limb-sparing techniques for upper and lower extremity sarcomas continue to evolve. Our experience has validated the composite thigh free flap as an excellent option for one-stage functional reconstruction of large limb defects.
带神经支配的肌肉转移可改善广泛保肢肉瘤切除术后的功能结局。我们报告了使用大腿复合组织瓣对大型肢体肿瘤缺损进行功能重建的经验。
2011年至2014年期间，3名男性和1名女性接受了4例保肢肿瘤切除术（3例下肢，1例上肢），术后立即采用大腿复合游离组织瓣进行功能重建。患者年龄在36至73岁之间。其中有3例软组织肉瘤和1例骨巨细胞瘤，均需切除整个肌肉间隔。组织瓣成分包括带感觉神经的筋膜皮组织、折叠的髂胫束（ITB）以及不同量的带运动神经的股外侧肌（VL）。
所有组织瓣均存活，无并发症。所有患者在6个月时均显示股外侧肌有运动神经支配。随访时间为20至36个月。肌力为2至5级（满分5级），活动范围为正常的25%至92%，肌肉骨骼肿瘤学会（MSTS）评分为22至29分（满分30分）。
上下肢肉瘤的保肢技术不断发展。我们的经验证实，大腿复合游离组织瓣是大型肢体缺损一期功能重建的极佳选择。
