Wang Chun-Meng, Zhang Ruming, Luo Peng, Wu Zhiqiang, Zheng Biqiang, Chen Yong, Shi Yingqiang
Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Surg Oncol. 2018 Feb;117(2):130-136. doi: 10.1002/jso.24823. Epub 2017 Oct 26.
Soft tissue sarcomas are rare neoplasms that can occur in the thoracic wall, abdominal wall, extremities, and inguinal region. Wide local resection, with precise histological margin control, results in large skin defects that are challenging to close. Various repair procedures, such as vertical rectus abdominis flaps (VRAM), latissimus dorsi flaps, and tensor fascia lata (TFL) flaps are used to cover broad thoracic wall defects. Although the cosmetic reconstruction results of using these flaps are often excellent, each has significant drawbacks. The external oblique musculocutaneous flap is a simple and safe surgical procedure for covering thoracic wall defects.
This study aimed to retrospectively assess the safety and technique of using the external oblique musculocutaneous flap to cover large thoracic wall defects after radical excision of locally advanced sarcomas in 20 patients at a single institution.
From January 2006 to December 2016, 20 Chinese patients with large advanced sarcomas on their trunks received wide local resection, with precise histological negative margins. The external oblique musculocutaneous flap, mobilized from the ipsilateral abdominal wall, was harvested to cover broad thoracic wall defects.
Among the 20 sarcoma patients (12 females and 8 males, ranging in age from 25 to 73 years), there were five patients with primary tumors and 15 patients with recurrent tumors. The median tumor diameter was approximately 15.3 cm. After excising the lesion, the median time to cover the defect with the external oblique myocutaneous flap was 66 min. The average blood loss when harvesting the flap was approximately 48 mL. For the 20 patients in our cohort, the external oblique flap achieved closure of defects measuring an average area of 256 cm . No other flaps or reconstruction techniques were used to cover the large defects in this study. There were no deaths directly related to the flap reconstruction procedures.
The external oblique musculocutaneous flap was a safe and reliable method of covering broad thoracic wall defects after radical tumor excision.
软组织肉瘤是一种罕见的肿瘤，可发生于胸壁、腹壁、四肢和腹股沟区。广泛局部切除并精确控制组织学切缘会导致较大的皮肤缺损，难以闭合。各种修复手术，如腹直肌肌皮瓣（VRAM）、背阔肌肌皮瓣和阔筋膜张肌（TFL）肌皮瓣，被用于覆盖广泛的胸壁缺损。尽管使用这些皮瓣进行美容重建的效果通常很好，但每种方法都有明显的缺点。腹外斜肌肌皮瓣是一种用于覆盖胸壁缺损的简单且安全的手术方法。
本研究旨在回顾性评估在一家机构中对20例患者使用腹外斜肌肌皮瓣覆盖局部晚期肉瘤根治性切除术后大的胸壁缺损的安全性和技术。
2006年1月至2016年12月，20例躯干患有大型晚期肉瘤的中国患者接受了广泛局部切除，组织学切缘阴性。从同侧腹壁切取腹外斜肌肌皮瓣来覆盖广泛的胸壁缺损。
在这20例肉瘤患者中（12例女性和8例男性，年龄范围为25至73岁），有5例原发性肿瘤患者和15例复发性肿瘤患者。肿瘤的中位直径约为15.3厘米。切除病变后，用腹外斜肌肌皮瓣覆盖缺损的中位时间为66分钟。切取皮瓣时的平均失血量约为48毫升。对于我们队列中的20例患者，腹外斜肌皮瓣成功闭合了平均面积为256平方厘米的缺损。本研究中未使用其他皮瓣或重建技术来覆盖大的缺损。没有直接与皮瓣重建手术相关的死亡病例。
腹外斜肌肌皮瓣是肿瘤根治性切除后覆盖广泛胸壁缺损的一种安全可靠的方法。
