Pedreira Rachel, Calotta Nicholas A, Deune E Gene
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA.
Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA.
Sarcoma. 2019 Feb 3;2019:3975020. doi: 10.1155/2019/3975020. eCollection 2019.
Sarcoma treatment necessitates high-dose chemoradiation therapy and wide surgical margins that create wounds that are difficult to reconstruct. Many techniques have been developed to cover these defects, originating with muscle flaps such as the rectus abdominis and latissimus dorsi. The gracilis flap, which is best known in contemporary practice as a microneurovascular flap for functional reconstructions, is not usually considered a robust option for reconstruction after sarcoma extirpation.
We reviewed records of 22 patients (9 women) at our institution who underwent reconstructive surgery after sarcoma extirpation using gracilis flaps for soft-tissue coverage from 1998 to 2017. Neurotized gracilis flaps were excluded. The mean patient age was 51 years (range, 18-85 years), and mean length of follow-up was 53 months (range, 9-156 months). Patients had 7 tumor types, with fibrosarcomas and undifferentiated tumors being most common. There were 23 defects (mean size, 118 cm (range, 54-200 cm)). Defects were located most commonly in the foot and leg (=9 each), upper extremity (=4), and head and neck (=1). The primary outcome was the flap success rate. Secondary outcomes were rates of major complications (unplanned reoperations, infections requiring intravenous antibiotics, and amputations); minor complications (superficial infections, partial skin-graft loss, partial flap necrosis, fluid collections treated in the office, and cosmetic reoperations); and sarcoma recurrence.
Twenty-one flaps (91%) survived. Six patients (27%) experienced a major complication, and 12 patients (54%) experienced a minor complication. There were 2 amputations, for a limb salvage rate of 91%.
This series shows that the gracilis is well suited to covering large, compromised wounds across diverse anatomic features, which are the hallmark of sarcoma resections. The high rate of limb salvage and minimal donor-site morbidity further support the use of this flap as a first-line option for sarcoma reconstruction.
肉瘤治疗需要高剂量的放化疗以及广泛的手术切缘，这会造成难以修复的伤口。已经开发出许多技术来覆盖这些缺损，最初是使用腹直肌和背阔肌等肌皮瓣。股薄肌皮瓣在当代实践中最常用于功能性重建的显微神经血管皮瓣，通常不被认为是肉瘤切除术后重建的可靠选择。
我们回顾了1998年至2017年在本机构接受肉瘤切除术后使用股薄肌皮瓣进行软组织覆盖的重建手术的22例患者（9名女性）的记录。排除神经化股薄肌皮瓣。患者的平均年龄为51岁（范围18 - 85岁），平均随访时间为53个月（范围9 - 156个月）。患者有7种肿瘤类型，其中纤维肉瘤和未分化肿瘤最为常见。共有23处缺损（平均大小为118平方厘米，范围54 - 200平方厘米）。缺损最常见于足部和腿部（各9处）、上肢（4处）以及头颈部（1处）。主要结局是皮瓣成功率。次要结局是主要并发症（计划外再次手术、需要静脉使用抗生素的感染以及截肢）的发生率；次要并发症（浅表感染、部分植皮丢失、部分皮瓣坏死、在门诊处理的积液以及美容修复手术）的发生率；以及肉瘤复发率。
21块皮瓣（91%）存活。6例患者（27%）出现主要并发症，12例患者（54%）出现次要并发症。有2例截肢，保肢率为91%。
本系列研究表明，股薄肌非常适合覆盖各种解剖部位的大而复杂的伤口，这是肉瘤切除的特征。高保肢率和最小的供区并发症进一步支持将该皮瓣作为肉瘤重建的一线选择。
