Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Chiba, Japan.
Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Chiba University, Chiba, Japan.
J Plast Surg Hand Surg. 2020 Dec;54(6):372-376. doi: 10.1080/2000656X.2020.1799817. Epub 2020 Jul 31.
Unplanned excision (UE) is defined as a procedure wherein a surgeon operates a tumor resection without appropriate preoperative diagnostic modalities and without the intent to achieve tumor-free margins. Generally, the reconstruction rate after UE is higher than that after planned excision (PE). The present study aimed to investigate how the reconstructive procedure and size of skin defect could be influenced. We reviewed the cases of 442 patients who underwent the resection of soft tissue sarcoma. Patients were stratified into two groups (UE vs. PE). We compared the histologic grade, skin defect, reconstructive procedures, depth of the reconstruction layer. For superficial reconstructions, we also compared procedures involving skin graft-only or flap. 105 cases (23.8%) were UE. Histologic grade in PE was significantly higher ( = .024). The reconstruction rate and size of skin defect in UE was significantly higher (76.2% vs. 27.3%, < .001) and larger (124.5 cm vs. 65.7 cm, < .001). The rate of deep layer reconstruction was significantly higher in PE (7.5% vs. 26.1%, = .001). In superficial reconstructions, 18 (24.3%) skin graft-only procedures were performed in UE and 15 (22.1%) in PE, all other superficial reconstructive procedures involved flap, and there was no significant difference ( = .45). Skin defects were 1.9 times larger after UE than PE. UE did not affect the superficial reconstructive procedure.
非计划性切除（UE）是指外科医生在没有适当的术前诊断手段且没有达到无肿瘤切缘的意图的情况下进行肿瘤切除术。一般来说，UE 后的重建率高于计划性切除（PE）后的重建率。本研究旨在探讨重建手术和皮肤缺损大小如何受到影响。我们回顾了 442 例软组织肉瘤切除术患者的病例。患者分为两组（UE 与 PE）。我们比较了组织学分级、皮肤缺损、重建手术、重建层深度。对于浅表重建，我们还比较了仅皮片移植或皮瓣的手术。105 例（23.8%）为 UE。PE 中的组织学分级显著更高（=.024）。UE 中的重建率和皮肤缺损大小显著更高（76.2%与 27.3%， < .001）且更大（124.5 cm 与 65.7 cm， < .001）。PE 中的深层重建率显著更高（7.5%与 26.1%， = .001）。在浅表重建中，UE 中有 18 例（24.3%）行单纯皮片移植术，PE 中有 15 例（22.1%），所有其他浅表重建手术均涉及皮瓣，无显著差异（ = .45）。UE 后的皮肤缺损比 PE 大 1.9 倍。UE 不影响浅表重建手术。
