Department of Paediatric Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
Department of Reconstructive and Oncologic Orthopaedics, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
BMC Cancer. 2018 Oct 20;18(1):1003. doi: 10.1186/s12885-018-4883-7.
Sarcomas that arise from the scapula or periscapular soft tissues often require a total scapulectomy. This often implies a large complex tissue defect that needs adequate reconstruction of both bone and soft tissue. Although various methods have been developed, no optimal procedure has emerged. Postoperative complications are common and functional recovery is not always satisfactory. This study aims to present a new surgical technique that combines a custom-made scapular prosthesis with a functional latissimus dorsi flap.
Two patients diagnosed with malignant tumour of the scapular region were surgically treated after proper multidisciplinary evaluation. The first patient underwent the procedure as a first surgery, the second as revision surgery. The new technique comprises three surgical stages: excisional surgery with soft tissue resection and scapulectomy, bone reconstruction with custom-made prosthesis, and soft tissue reconstruction using a latissimus dorsi rotational flap overturned on the prosthesis. The goal is to set up a new functional unit combining an anatomically shaped implant (manufactured using latest three-dimensional printing technology) and a muscular flap, and to maintain the neurovascular supply. The patients were followed up to evaluate functional outcome and complications. Both patients were alive with no evidence of disease. Functional results were satisfactory and the Musculoskeletal Tumor Society scores were 87% and 63%, respectively. No surgical complications such as implant breakage, joint collapse, wound dehiscence, or infection were observed.
This new technique upgrades the role of the latissimus dorsi flap to a functional tool in combination with an anatomical, three-dimensionally printed, custom-made prosthesis, and provides adequate well-vascularized and healthy tissue to maximize the likelihood of successful limb salvage.
起源于肩胛骨或肩胛周围软组织的肉瘤常需要全肩胛骨切除术。这通常意味着需要对骨和软组织进行充分的重建，以弥补巨大而复杂的组织缺损。尽管已经开发出各种方法，但仍未出现最佳方法。术后并发症很常见，功能恢复也并不总是令人满意。本研究旨在介绍一种新的手术技术，该技术将定制的肩胛骨假体与功能性背阔肌皮瓣相结合。
两名被诊断为肩胛骨区域恶性肿瘤的患者在经过适当的多学科评估后接受了手术治疗。第一位患者接受了初次手术，第二位患者接受了翻修手术。新技术包括三个手术阶段：切除手术，包括软组织切除和肩胛骨切除术；使用定制假体进行骨重建；使用翻转到假体上的背阔肌旋转皮瓣进行软组织重建。目标是建立一个新的功能单位，将解剖形状的植入物（使用最新的三维打印技术制造）和肌肉瓣结合起来，并保持神经血管供应。对患者进行随访以评估功能结果和并发症。两名患者均存活且无疾病迹象。功能结果令人满意，肌肉骨骼肿瘤学会评分分别为 87%和 63%。未观察到手术并发症，如植入物断裂、关节塌陷、伤口裂开或感染。
这项新技术将背阔肌皮瓣的作用提升为一种功能性工具，与解剖学、三维打印、定制假体相结合，提供充足的血运良好和健康的组织，以最大限度地提高成功保肢的可能性。
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