Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Orthop Surg. 2022 Feb;14(2):215-220. doi: 10.1111/os.12840. Epub 2021 Dec 13.
This study aims to determine outcomes and complications in functional reconstruction of soft tissue defects after surgical resection for soft tissue sarcomas (STSs) of extremities.
A retrospective chart review was performed on patients with STSs of extremities from May 2015 to April 2019 who underwent radical resection of STSs and reconstruction of soft tissue defect with free vascularized anterolateral thigh flap (FVALTP). A minimum 3-month follow-up was required for all the patients. Patient demographics and comorbidities, flap characteristics, postoperative complications, and time to heal were recorded. The functional outcomes of the reconstructed limbs were assessed by the Musculoskeletal Tumour Society（MSTS） scoring system.
A total of 11 patients (four males and seven females) were included in the study. The mean age was 62 years (range: 29-84 years). The mean surface area was 151.4 cm (range: from 64 cm to 418cm ). The mean operation time was 126 min (range: 95-296 min). The mean follow-up was 17.5 months (range: 6-34 months). The mean score of MSTS at last follow-up was 26.2 (range: 12-29). Incision healed by first intention in eight patients. Incision healed by second intention in three patients. A patient who had received preoperative radiotherapy experienced delayed union. After debridement, the patient successfully got union. Another two patients experienced marginal necrosis of flap due to vascular crisis. After 3-week dressing changes, the patients also got satisfactory union. One case suffered from vascular crisis during surgery in which the procedure was changed into skin grafting to cover resection site.
FVALTP technique can be effectively applied to the reconstruction of soft tissue defect after STSs resection. The short-term follow-up indicated satisfactory functional outcome and low incidence of previously known complications. It was necessary to further validate its efficacy in reconstruction of soft tissue defect after malignant extremity soft tissue sarcoma resection.
本研究旨在确定四肢软组织肉瘤（STS）切除术后功能性软组织缺损重建的结果和并发症。
对 2015 年 5 月至 2019 年 4 月间因 STS 接受根治性切除术和游离股前外侧皮瓣（FVALTP）软组织缺损重建的四肢 STS 患者进行回顾性病历分析。所有患者均需至少随访 3 个月。记录患者的人口统计学和合并症、皮瓣特征、术后并发症和愈合时间。采用肌肉骨骼肿瘤学会（MSTS）评分系统评估重建肢体的功能结果。
共纳入 11 例患者（4 例男性，7 例女性）。平均年龄为 62 岁（范围：29-84 岁）。平均皮瓣面积为 151.4cm（范围：64-418cm）。平均手术时间为 126 分钟（范围：95-296 分钟）。平均随访时间为 17.5 个月（范围：6-34 个月）。末次随访时 MSTS 的平均评分为 26.2（范围：12-29）。8 例患者切口一期愈合，3 例患者切口二期愈合。1 例接受术前放疗的患者出现延迟愈合，经清创后成功愈合。另外 2 例患者因血管危象出现皮瓣边缘坏死，经 3 周换药后也获得满意愈合。1 例患者术中发生血管危象，改为植皮覆盖切除部位。
FVALTP 技术可有效应用于 STS 切除术后软组织缺损的重建。短期随访结果表明功能结局满意，已知并发症发生率低。有必要进一步验证其在恶性肢体软组织肉瘤切除术后软组织缺损重建中的疗效。
