Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France.
Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France; Inserm UN UMR 1238, PhyOs, bone sarcomas and remodeling of calcified tissues, faculté de médecine de Nantes, 44000 Nantes, France.
Orthop Traumatol Surg Res. 2019 Feb;105(1):47-54. doi: 10.1016/j.otsr.2018.10.018. Epub 2018 Dec 27.
Tumor resection is the gold standard treatment for soft tissue and bone sarcomas. In the pelvis, this may require a hemipelvectomy that can compromise primary skin closure. Flaps are essential in this context; however the vascularization of potential pedicled flaps may have been removed during tumor excision. Using healthy tissue from the amputated limb as a free flap is an excellent coverage option.
The free fillet flap from an amputated lower limb is a simple and reliable coverage technique after hemipelvectomy or hip disarticulation.
Seven patients were operated on at three specialty centers: six transpelvic amputations (external hemipelvectomy) and one hip disarticulation. In three cases, the flap consisted of the superficial posterior compartment of the calf area and in the three other cases, the lower leg compartments with the fibula and its intact periosteum. Complications were documented.
Clear resection margins were achieved in all patients. The mean follow-up at the final visit was 13 months (range, 6.5 to 21 months). Six patients had complications but only one resulted in loss of the flap. Four patients were able to be fitted with a hip prosthesis.
The free fillet flap from an amputated lower limb is a reliable coverage technique (86%) after hemipelvectomy or hip disarticulation. In the 16 cases previously reported in the literature, there were no wound-healing failures. Local flaps are often too fragile with insufficient muscular padding. This free flap is the preferred first-line technique as it spares other potential free flaps in case of failure without increasing the morbidity of a procedure that is already extensive. This coverage technique should be one the options considered after external hemipelvectomy.
IV, retrospective study.
肿瘤切除术是软组织肉瘤和骨肉瘤的金标准治疗方法。在骨盆中，这可能需要进行半骨盆切除术，这可能会导致原发性皮肤无法闭合。在这种情况下，皮瓣是必不可少的；然而，肿瘤切除过程中可能已经去除了潜在带蒂皮瓣的血管化。使用截肢肢体的健康组织作为游离皮瓣是一种极好的覆盖选择。
从截肢的下肢获得的游离鱼际皮瓣是半骨盆切除术或髋关节离断术后的一种简单可靠的覆盖技术。
在三个专业中心对七名患者进行了手术：六例经盆部截肢（外半骨盆切除术）和一例髋关节离断术。在三种情况下，皮瓣由小腿后浅层间隔组成，在另外三种情况下，小腿间隔包括腓骨及其完整的骨膜。记录了并发症。
所有患者均达到明确的切除边缘。最终随访时的平均随访时间为 13 个月（范围 6.5 至 21 个月）。六名患者出现并发症，但只有一名患者皮瓣失活。四名患者能够安装髋关节假体。
从截肢的下肢获得的游离鱼际皮瓣是半骨盆切除术或髋关节离断术后可靠的覆盖技术（86%）。在文献中之前报告的 16 例中，没有出现伤口愈合失败的情况。局部皮瓣通常过于脆弱，肌肉填充不足。这种游离皮瓣是首选的一线技术，因为它可以在失败时避免其他潜在的游离皮瓣，而不会增加已经广泛的手术的发病率。这种覆盖技术应该是外半骨盆切除术后的一种选择。
IV，回顾性研究。
Zotero 插件