Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, United States.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, United States.
J Plast Reconstr Aesthet Surg. 2021 Jun;74(6):1246-1252. doi: 10.1016/j.bjps.2020.10.054. Epub 2020 Nov 4.
Radiation therapy causes histopathologic changes in tissues, including fibrosis, loss of tissue planes, and vascular damage, which can lead to chronic wound formation. Patients with nonhealing, irradiated wounds and comorbidities that affect microvasculature suffer a "double hit", which leads to delayed wound healing. Local wound care and grafts are commonly insufficient. In this study, we evaluated limb salvage outcomes and long-term complications after free tissue transfer (FTT) in patients with chronic, irradiated leg wounds.
We retrospectively reviewed patients with irradiated lower extremity wounds who underwent FTT from 2012 to 2017. Primary outcomes included limb salvage, ambulation, and overall flap success. Reconstruction involved complete excision of irradiated tissue and coverage with well-vascularized tissue.
Seven free flaps in six patients were identified. Average age was 68.4 years and average BMI was 27.8 kg/m. Comorbid conditions included hypertension (57.1%), peripheral vascular disease (57.1%), underlying hypercoagulability (42.9%), diabetes (14.3%), and tobacco use (14.3%). Wounds were present for an average of 25.5 months prior to FTT. Donor sites included anterolateral thigh (71.4%), vastus lateralis (14.3%), and latissimus dorsi (14.3%). Overall flap success rate was 100% with one patient requiring reoperation for dehiscence. Limb salvage rate was 85.7% with one patient undergoing elective amputation due to pain. All patients could ambulate (one used a prosthesis) at a mean follow-up time of 1.4 years.
Radiation therapy in a comorbid population often leads to the formation of chronic nonhealing wounds. We advocate for earlier consideration of FTT to provide healthy vascularized tissues, thereby avoiding prolonged wound care and patient burden. Successful limb salvage outcomes can be achieved.
放射治疗会导致组织的组织病理学变化，包括纤维化、组织平面丧失和血管损伤，这可能导致慢性伤口形成。患有非愈合性、放射性伤口和影响微血管的合并症的患者受到“双重打击”，导致伤口愈合延迟。局部伤口护理和移植物通常不足。在这项研究中，我们评估了接受慢性放射性腿部伤口游离组织转移（FTT）的患者的肢体保留结果和长期并发症。
我们回顾性地审查了 2012 年至 2017 年间接受 FTT 的放射性下肢伤口患者。主要结果包括肢体保留、行走和整体皮瓣成功。重建包括放射性组织的完全切除和血运良好的组织覆盖。
在六名患者中确定了七个游离皮瓣。平均年龄为 68.4 岁，平均 BMI 为 27.8kg/m。合并症包括高血压（57.1%）、周围血管疾病（57.1%）、潜在高凝状态（42.9%）、糖尿病（14.3%）和吸烟（14.3%）。在接受 FTT 之前，伤口存在的平均时间为 25.5 个月。供区包括前外侧大腿（71.4%）、股外侧肌（14.3%）和背阔肌（14.3%）。总的皮瓣成功率为 100%，一名患者因切口裂开需要再次手术。肢体保留率为 85.7%，一名患者因疼痛而选择性截肢。所有患者在平均 1.4 年的随访时间内均可行走（一名使用假肢）。
合并症患者的放射治疗常常导致慢性不愈合伤口的形成。我们主张更早地考虑 FTT，以提供健康的血管化组织，从而避免长期的伤口护理和患者负担。可以实现成功的肢体保留结果。
