Chan Lester Wai Mon, Imanishi Jungo, Grinsell Damien Glen, Choong Peter
Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia.
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Front Surg. 2018 Jan 22;4:79. doi: 10.3389/fsurg.2017.00079. eCollection 2017.
Surgery in combination with radiotherapy (RT) has become the standard of care for most soft tissue sarcomas. The choice between pre- and postoperative RT is controversial. Preoperative RT is associated with a 32-35% rate of major wound complications (MWC) and 16-25% rate of reoperation. The role of vascularized soft tissue "flaps" in reducing complications is unclear. We report the outcomes of patients treated with preoperative RT, resection, and flap reconstruction.
122 treatment episodes involving 117 patients were retrospectively reviewed. All patients were treated with 50.4 Gy of external beam radiation. Surgery was performed at 4-8 weeks after completion of RT by the same combination of orthopedic oncology and plastic reconstructive surgeon. Defects were reconstructed with 64 free and 59 pedicled/local flaps.
30 (25%) patients experienced a MWC and 17 (14%) required further surgery. 20% of complications were exclusively related to the donor site. There was complete or partial loss of three flaps. There was no difference in the rate of MWC or reoperation for complications with respect to age, sex, tumor site, previous unplanned excision, tumor grade, depth, and type of flap. Tumor size ≥8 cm was associated with a higher rate of reoperation (11/44 vs 6/78; = 0.008) but the rate of MWC was not significant (16/44 vs 14/78; = 0.066).
The use of soft tissue flaps is associated with a low rate of MWC and reoperation. Our results suggest that a high rate of flap usage may be required to observe a reduction in complication rates.
手术联合放疗（RT）已成为大多数软组织肉瘤的标准治疗方法。术前放疗和术后放疗的选择存在争议。术前放疗与32%-35%的严重伤口并发症（MWC）发生率以及16%-25%的再次手术率相关。带血管软组织“皮瓣”在减少并发症方面的作用尚不清楚。我们报告了接受术前放疗、切除和皮瓣重建治疗的患者的治疗结果。
回顾性分析了117例患者的122次治疗过程。所有患者均接受50.4Gy的外照射放疗。放疗结束后4-8周，由骨科肿瘤外科医生和整形重建外科医生联合进行手术。用64个游离皮瓣和59个带蒂/局部皮瓣修复缺损。
30例（25%）患者发生严重伤口并发症，17例（14%）需要进一步手术。20%的并发症仅与供区有关。有3个皮瓣完全或部分坏死。严重伤口并发症或再次手术并发症的发生率在年龄、性别、肿瘤部位、既往意外切除史、肿瘤分级、深度和皮瓣类型方面无差异。肿瘤大小≥8cm与较高的再次手术率相关（11/44 vs 6/78；P=0.008），但严重伤口并发症的发生率无显著差异（16/44 vs 14/78；P=0.066）。
使用软组织皮瓣与较低的严重伤口并发症和再次手术率相关。我们的结果表明，可能需要较高的皮瓣使用率才能观察到并发症发生率的降低。
