Ehrl Denis, Wachtel Nikolaus, Braig David, Kuhlmann Constanze, Dürr Hans Roland, Schneider Christian P, Giunta Riccardo E
Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
Orthopaedic Oncology, Department of Orthopaedics and Trauma Surgery, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
J Pers Med. 2022 Apr 1;12(4):560. doi: 10.3390/jpm12040560.
Autologous fillet flaps are a common reconstructive option for large defects after forequarter amputation (FQA) due to advanced local malignancy or trauma. The inclusion of osseous structures into these has several advantages. This article therefore systematically reviews reconstructive options after FQA, using osteomusculocutaneous fillet flaps, with emphasis on personalized surgical technique and outcome. Additionally, we report on a case with an alternative surgical technique, which included targeted muscle reinnervation (TMR) of the flap. Our literature search was conducted in the PubMed and Cochrane databases. Studies that were identified were thoroughly scrutinized with regard to relevance, resulting in the inclusion of four studies (10 cases). FQA was predominantly a consequence of local malignancy. For vascular supply, the brachial artery was predominantly anastomosed to the subclavian artery and the brachial or cephalic vein to the subclavian or external jugular vein. Furthermore, we report on a case of a large osteosarcoma of the humerus. Extended FQA required the use of the forearm for defect coverage and shoulder contour reconstruction. Moreover, we performed TMR. Follow-up showed a satisfactory result and no phantom limb pain. In case of the need for free flap reconstruction after FQA, this review demonstrates the safety and advantage of osteomusculocutaneous fillet flaps. If the inclusion of the elbow joint into the flap is not possible, we recommend the use of the forearm, as described. Additionally, we advocate for the additional implementation of TMR, as it can be performed quickly and is likely to reduce phantom limb and neuroma pain.
自体带蒂皮瓣是因局部晚期恶性肿瘤或创伤行前侧半肢体截肢（FQA）后修复大创面的常用方法。将骨结构纳入其中有诸多优势。因此，本文系统回顾了采用骨肌皮瓣修复FQA后的重建方法，重点关注个性化手术技术及效果。此外，我们报告了1例采用替代手术技术的病例，该技术包括对皮瓣进行靶向肌肉再支配（TMR）。我们在PubMed和Cochrane数据库中进行了文献检索。对检索到的研究进行了相关性的全面审查，最终纳入4项研究（10例病例）。FQA主要由局部恶性肿瘤导致。在血管吻合方面，肱动脉主要与锁骨下动脉吻合，肱静脉或头静脉与锁骨下静脉或颈外静脉吻合。此外，我们报告了1例肱骨巨大骨肉瘤病例。广泛的FQA需要利用前臂来覆盖创面并重建肩部外形。此外，我们实施了TMR。随访结果显示效果满意，且未出现幻肢痛。对于FQA后需要游离皮瓣重建的情况，本综述证明了骨肌皮瓣的安全性和优势。如果无法将肘关节纳入皮瓣，我们建议按所述使用前臂。此外，我们主张额外实施TMR，因为其操作迅速，且可能减轻幻肢痛和神经瘤疼痛。
