From the Department of Orthopedic Surgery and the Division of Plastic and Reconstructive Surgery, Mayo Clinic.
Plast Reconstr Surg. 2018 Nov;142(5):1327-1335. doi: 10.1097/PRS.0000000000004890.
The vertical rectus abdominis myocutaneous flap has been used to reliably reconstruct posterior soft-tissue defects following resection of high sacral tumors, providing skin and soft-tissue bulk. Current literature examining the use of these flaps for high sacral reconstruction is limited. The purpose of this study was to report the authors' institution's outcome on the use of the vertical rectus abdominis myocutaneous flap to reconstruct a high sacral defect following an oncologic resection.
Eighty-seven patients (29 female and 58 male) underwent vertical rectus abdominis myocutaneous flap surgery to reconstruct a posterior wound following high sacral tumor resection from 1994 to 2016. The mean age and body mass index were 52 years and 27.8 kg/m(2), respectively. The mean follow-up was 6 years.
Sixty-eight patients (79 percent) sustained a complication, most commonly a wound complication [n = 41 (47 percent)]. Twenty patients (23 percent) sustained a donor-site wound complication, most commonly a wound dehiscence (n = 10). Complications resulted in a reoperation in 44 patients (51 percent), with total flap failure occurring in one (1 percent). Preoperative radiotherapy and obesity were found to increase the risk of wound complications (p = 0.004 and p = 0.02, respectively) and deep infection (p = 0.03 and p = 0.02, respectively).
Complications were common following vertical rectus abdominis myocutaneous flap surgery; however, total flap loss was not. Patients with obesity and preoperative radiotherapy should be cautioned on their increased risk of complications. Currently, the vertical rectus abdominis myocutaneous flap is the authors' preferred means of soft-tissue reconstruction following high sacral tumor resection.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
垂直腹直肌肌皮瓣已被用于可靠地重建高位骶骨肿瘤切除后的后软组织缺损，提供皮肤和软组织体积。目前关于这些皮瓣用于高位骶骨重建的文献有限。本研究的目的是报告作者所在机构使用垂直腹直肌肌皮瓣重建高位骶骨缺损的结果。
1994 年至 2016 年，87 例（29 例女性，58 例男性）患者因高位骶骨肿瘤切除后后伤口接受垂直腹直肌肌皮瓣手术。患者的平均年龄和 BMI 分别为 52 岁和 27.8kg/m²。平均随访时间为 6 年。
68 例（79％）患者发生并发症，最常见的是伤口并发症[41 例（47％）]。20 例（23％）患者发生供区伤口并发症，最常见的是伤口裂开（10 例）。并发症导致 44 例（51％）患者再次手术，其中一例（1％）出现全皮瓣失败。术前放疗和肥胖被发现增加了伤口并发症（p=0.004 和 p=0.02）和深部感染（p=0.03 和 p=0.02）的风险。
垂直腹直肌肌皮瓣手术后并发症常见，但全皮瓣坏死并不常见。肥胖和术前放疗的患者应注意其并发症风险增加。目前，垂直腹直肌肌皮瓣是作者在高位骶骨肿瘤切除后首选的软组织重建方法。
临床问题/证据水平：治疗，IV。
