MacArthur Ian R, McInnes Colin W, Dalke Kim R, Akra Mohamed, Banerji Shantanu, Buchel Edward W, Hayakawa Thomas J
Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, MB, Canada.
Department of Radiation Oncology, University of Manitoba, Winnipeg, MB, Canada.
J Reconstr Microsurg. 2019 Mar;35(3):168-175. doi: 10.1055/s-0038-1668116. Epub 2018 Aug 18.
Lower extremity soft tissue sarcoma treatment has evolved from primarily amputation procedures toward limb salvage. This series assesses whether soft tissue sarcoma tissue defects, extensive enough to require microsurgical reconstruction, can reliably result in preservation of ambulation, as well as objectively evaluate functional outcomes utilizing a patient-reported validated scale. It will also look at whether immediate functional muscle reconstructions and tendon transfers can be successful at restoring ambulation, potentially expanding the indications for limb salvage procedures.
A retrospective review of all microsurgical reconstructions for limb salvage in lower extremity sarcoma patients was completed at our institution (2009-2013). Patients were additionally asked to complete the Toronto Extremity Salvage Score(TESS) quality of life survey.
Over a 5-year period, 23 patients (mean age: 53 years) underwent free flap reconstructions for 23 sarcomas (mean follow-up: 14 months). Seventy-eight percent of patients received neoadjuvant radiation. The thigh was the most common tumor site (61%) and three muscles were resected on average. Perforator flaps were most frequently used (61%), and functional muscle transfers or immediate tendon transfers were used in four patients. There were no flap take-backs or failures, and 22 patients achieved independent ambulation. Three patients in the series died, two from metastatic disease found postoperatively and one from local recurrence. A 74% response rate was achieved for the TESS survey, with a mean score of 83.
Microsurgical reconstruction of lower extremity sarcoma defects enables preservation of independent ambulation. Restoration of function utilizing immediate functional microsurgical reconstructions and tendon transfers should be considered.
下肢软组织肉瘤的治疗已从主要的截肢手术发展为保肢手术。本系列研究评估了软组织肉瘤组织缺损大到需要显微外科重建时，能否可靠地实现行走功能的保留，并利用患者报告的有效量表客观评估功能结果。还将研究即刻功能性肌肉重建和肌腱转移能否成功恢复行走功能，这可能会扩大保肢手术的适应症。
我们机构对所有下肢肉瘤患者保肢显微外科重建手术进行了回顾性研究（2009 - 2013年）。此外，还要求患者完成多伦多肢体 salvage 评分（TESS）生活质量调查。
在5年期间，23例患者（平均年龄：53岁）因23例肉瘤接受了游离皮瓣重建手术（平均随访时间：14个月）。78%的患者接受了新辅助放疗。大腿是最常见的肿瘤部位（61%），平均切除了三块肌肉。最常使用穿支皮瓣（61%），4例患者采用了功能性肌肉转移或即刻肌腱转移。没有皮瓣坏死或失败的情况，22例患者实现了独立行走。该系列中有3例患者死亡，2例死于术后发现的转移性疾病，1例死于局部复发。TESS 调查的回复率为74%，平均得分为83分。
下肢肉瘤缺损的显微外科重建能够保留独立行走功能。应考虑利用即刻功能性显微外科重建和肌腱转移来恢复功能。
