Hassan Abbas M, Tesfaye Eliora A, Rashiwala Abhi, Roubaud Margaret J, Mericli Alexander F
Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
J Reconstr Microsurg. 2023 Mar;39(3):195-208. doi: 10.1055/a-1887-7530. Epub 2022 Jun 29.
Functional muscle transfer (FMT) can provide wound closure and restore adequate muscle function for patients with oncologic extremity defects. Herein we describe our institutional experience with FMT after oncological resection and provide a systematic review and meta-analysis of the available literature on this uncommon procedure.
A single-institution retrospective review was performed, including all patients who received FMT after oncological resection from 2005 to 2021. For the systematic review and meta-analysis, PubMed, Cochrane, Medline, and Embase libraries were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; results were pooled, weighted by study size, and analyzed.
The meta-analysis consisted of seven studies with 70 patients overall, demonstrating a mean Medical Research Council (MRC) score of 3.78 (95% confidence interval: 2.97-4.56; < 0.01). The systematic review included 28 studies with 103 patients. Receipt of adjuvant chemotherapy was associated with significantly lower mean MRC score (3.00 ± 1.35 vs. 3.90 ± 1.36; = 0.019). Seventy-four percent of the patients underwent free FMT, with the most common donor muscle being the latissimus dorsi (55%). The flap loss rate was 0.8%. Neoadjuvant chemotherapy ( = 0.03), radiotherapy ( = 0.05), pedicled FMTs ( = 0.01), and a recipient femoral nerve ( = 0.02) were associated with significantly higher complication rates. The institutional retrospective review identified 13 patients who underwent FMT after oncological resection with a median follow-up time of 21 months (range: 6-74 months). The most common tumor necessitating FMT was undifferentiated pleomorphic sarcoma (77%), and the most common donor muscle was the latissimus dorsi (62%). A high body mass index was associated with prolonged neuromuscular recovery ( = 0.87, = 0.002).
FMT after oncological resection may contribute to improved extremity function. Careful consideration of risk factors and preoperative planning is imperative for successful FMT outcomes.
功能性肌肉转移（FMT）可为患有肢体肿瘤性缺损的患者实现伤口闭合并恢复足够的肌肉功能。在此，我们描述了我们机构在肿瘤切除术后进行FMT的经验，并对关于这一不常见手术的现有文献进行了系统回顾和荟萃分析。
进行了一项单机构回顾性研究，纳入了2005年至2021年间所有在肿瘤切除术后接受FMT的患者。对于系统回顾和荟萃分析，根据系统评价和荟萃分析的首选报告项目指南对PubMed、Cochrane、Medline和Embase数据库进行检索；汇总结果，按研究规模加权并进行分析。
荟萃分析纳入了7项研究，共70例患者，平均医学研究委员会（MRC）评分为3.78（95%置信区间：2.97 - 4.56；P < 0.01）。系统回顾纳入了28项研究，共103例患者。接受辅助化疗与显著更低的平均MRC评分相关（3.00 ± 1.35 vs. 3.90 ± 1.36；P = 0.019）。74%的患者接受了游离FMT，最常见的供体肌肉是背阔肌（55%）。皮瓣丢失率为0.8%。新辅助化疗（P = 0.03）、放疗（P = 0.05）、带蒂FMT（P = 0.01）以及受区股神经（P = 0.02）与显著更高的并发症发生率相关。机构回顾性研究确定了13例在肿瘤切除术后接受FMT的患者，中位随访时间为21个月（范围：6 - 74个月）。需要FMT的最常见肿瘤是未分化多形性肉瘤（77%），最常见的供体肌肉是背阔肌（62%）。高体重指数与神经肌肉恢复时间延长相关（P = 0.87，P = 0.002）。
肿瘤切除术后的FMT可能有助于改善肢体功能。为获得成功的FMT结果，必须仔细考虑风险因素并进行术前规划。
