Wu Peter, Elswick Sarah M, Arkhavan Arya, Molinar Vanessa E, Mohan Anita T, Curiel Daniel, Sim Frank H, Martinez-Jorge Jorys, Saint-Cyr Michel
Division of Plastic Surgery, Mayo Clinic, Rochester, Minn.
Mayo Clinic School of Medicine, Rochester, Minn.
Plast Reconstr Surg Glob Open. 2020 Jul 23;8(7):e2912. doi: 10.1097/GOX.0000000000002912. eCollection 2020 Jul.
Secondary lymphedema can be a lifelong and debilitating consequence of lower extremity oncologic resection and reconstruction. The goal of this study was to identify risk factors for the development of lymphedema in patients treated for thigh sarcoma.
A retrospective review analyzed all patients who underwent thigh sarcoma resection and reconstruction by a plastic surgeon at the Mayo Clinic between 1997 and 2014. Patient demographics, tumor characteristics, surgical management, adjunctive therapies, and complications of patients who did and did not develop postoperative lymphedema were compared.
A total of 148 patients were identified. Twelve percent of patients developed lymphedema postoperatively during an average follow-up of 26 months. Risk factors for the development of lymphedema included defect location in the medial thigh ( = 0.04), arterial resection ( = 0.001), arterial reconstruction ( = 0.027), and a history of cardiac disease ( = 0.03). Twenty-two percent of patients who developed lymphedema also experienced wound dehiscence compared with 4.6% of patients without lymphedema ( = 0.02). There were no differences in age, body mass index, smoking, history of deep venous thrombosis or venous stasis, wound dimensions, or type of reconstruction performed in patients with and without lymphedema.
Lymphedema is common following major oncologic resection. Preexisting cardiac disease, tumor location in the medial thigh, and arterial resection and reconstruction were associated with a higher risk of postoperative lymphedema. Noninfectious wound dehiscence may be secondary to lymphedema or represent an early indicator of patients who will ultimately develop lymphedema.
继发性淋巴水肿可能是下肢肿瘤切除和重建术后的一种终身性且使人衰弱的后果。本研究的目的是确定大腿肉瘤患者发生淋巴水肿的危险因素。
一项回顾性研究分析了1997年至2014年间在梅奥诊所接受大腿肉瘤切除和重建手术的所有患者。比较了发生和未发生术后淋巴水肿患者的人口统计学特征、肿瘤特征、手术管理、辅助治疗及并发症。
共纳入148例患者。在平均26个月的随访期间，12%的患者术后发生淋巴水肿。发生淋巴水肿的危险因素包括大腿内侧缺损部位（P = 0.04）、动脉切除（P = 0.001）、动脉重建（P = 0.027）以及心脏病史（P = 0.03）。发生淋巴水肿的患者中有22%也出现伤口裂开，而未发生淋巴水肿的患者中这一比例为4.6%（P = 0.02）。发生和未发生淋巴水肿的患者在年龄、体重指数、吸烟、深静脉血栓形成或静脉淤滞病史、伤口大小或重建类型方面没有差异。
大型肿瘤切除术后淋巴水肿很常见。存在心脏病史、肿瘤位于大腿内侧以及动脉切除和重建与术后淋巴水肿风险较高相关。非感染性伤口裂开可能继发于淋巴水肿或代表最终会发生淋巴水肿患者的早期指标。
