Slump Jelena, Hofer Stefan O P, Ferguson Peter C, Wunder Jay S, Griffin Anthony M, Hoekstra Harald J, Bastiaannet Esther, O'Neill Anne C
Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada; Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.
J Plast Reconstr Aesthet Surg. 2018 Jul;71(7):989-996. doi: 10.1016/j.bjps.2018.04.002. Epub 2018 Apr 12.
Flap reconstruction plays an essential role in facilitating limb preservation in patients with extremity soft tissue sarcoma (ESTS). However, the effect of flap choice on the rates of postoperative complications and functional outcomes has not been clearly established. This study directly compares the outcomes of free and pedicled flap reconstructions in patients with ESTS.
Two hundred sixty-six patients who underwent flap reconstruction following ESTS resection were included. Associations between flap type and complications were determined using logistic regression analyses. Functional outcome was evaluated using the Toronto Extremity Salvage Score (TESS) and the Musculoskeletal Tumor Society Scales (MSTS).
There was no significant difference between complication rates in the pedicled and free flap groups (32% vs. 38%, p = 0.38). In the lower limb, pedicled flaps had complication rates similar to those of free flaps on univariate analysis (odds ratio [OR] = 1.12, 95% confidence interval [CI] = 0.56-2.26, p = 0.75). Conversely, in the upper limb, pedicled flaps were associated with fewer complications on univariate analysis (OR = 0.31, 95% CI = 0.11-0.86, p = 0.03), but this was not significant on multivariate analysis (OR = 0.45, 95% CI = 0.13-1.59, p = 0.22). Obesity was a strong predictor of complications in the upper limb group on multivariate analysis (body mass index [BMI] ≥ 30 kg/m, OR = 7.01, 95% CI = 1.28-38.51, p = 0.03). There was no significant difference in functional outcomes between both flap groups in either upper or lower limbs.
Postoperative complications and functional outcomes for patients undergoing free and pedicled flaps are similar in ESTS reconstruction. Selecting the most suitable reconstructive option in each individual case is paramount to preserving function while minimizing postoperative morbidity.
皮瓣重建在促进肢体软组织肉瘤（ESTS）患者的肢体保全方面起着至关重要的作用。然而，皮瓣选择对术后并发症发生率和功能结局的影响尚未明确。本研究直接比较了ESTS患者游离皮瓣和带蒂皮瓣重建的结局。
纳入266例ESTS切除术后接受皮瓣重建的患者。使用逻辑回归分析确定皮瓣类型与并发症之间的关联。使用多伦多肢体挽救评分（TESS）和肌肉骨骼肿瘤学会量表（MSTS）评估功能结局。
带蒂皮瓣组和游离皮瓣组的并发症发生率无显著差异（32%对38%，p = 0.38）。在下肢，单因素分析显示带蒂皮瓣的并发症发生率与游离皮瓣相似（优势比[OR]=1.12，95%置信区间[CI]=0.56 - 2.26，p = 0.75）。相反，在上肢，单因素分析显示带蒂皮瓣的并发症较少（OR = 0.31，95% CI = 0.11 - 0.86，p = 0.03），但多因素分析无显著性差异（OR = 0.45，95% CI = 0.13 - 1.59，p = 0.22）。多因素分析显示肥胖是上肢组并发症的强预测因素（体重指数[BMI]≥30 kg/m，OR = 7.01，95% CI = 1.28 - 38.51，p = 0.03）。上下肢两组皮瓣的功能结局均无显著差异。
在ESTS重建中，接受游离皮瓣和带蒂皮瓣的患者术后并发症和功能结局相似。在每个病例中选择最合适的重建方案对于保留功能同时最小化术后发病率至关重要。
