Roubaud Margaret, Asaad Malke, Liu Jun, Mericli Alexander, Kapur Sahil, Adelman David, Hanasono Matthew
From the Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center.
Department of Plastic Surgery, University of Pittsburgh Medical Center.
Plast Reconstr Surg. 2023 Oct 1;152(4):883-895. doi: 10.1097/PRS.0000000000010294. Epub 2023 Feb 14.
Extremely high-level lower extremity amputations are rare procedures that require significant soft-tissue and bony reconstruction. This study describes the use of fillet flaps for oncologic reconstruction and the incorporation of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNIs) for chronic pain prevention.
The authors performed a retrospective review of patients who underwent lower extremity fillet flaps at MD Anderson Cancer Center from January of 2004 through April of 2021. Surgical outcomes were summarized and compared. Numeric rating scale and patient-reported outcomes measures were collected.
Thirty-eight fillet flaps were performed for lower extremity reconstruction. Extirpative surgery included external hemipelvectomy (42%), external hemipelvectomy with sacrectomy (32%), and supratrochanteric above-knee amputation (26%). Median defect size was 600 cm 2 , and 50% included a bony component. Twenty-one patients (55%) experienced postoperative complications, with 16 requiring operative intervention. There was an increased trend toward complications in patients with preoperative radiotherapy, although this was not significant (44% versus 65%; P = 0.203). Seven patients underwent TMR or RPNI. In these patients, the mean numeric rating scale residual limb pain score was 2.8 ± 3.4 ( n = 5; range, 0 to 4/10) and phantom limb pain was 4 ± 3.2 ( n = 6; range, 0 to 7/10). The mean Patient-Reported Outcomes Measures Information Systems T scores were as follows: pain intensity, 50.8 ± 10.6 ( n = 6; range, 30.7 to 60.5); pain interference, 59.2 ± 12.1 ( n = 5; range, 40.7 to 70.1); and pain behavior, 62.3 ± 6.7 ( n = 3; range, 54.6 to 67.2).
Lower limb fillet flaps are reliable sources of bone, soft tissue, and nerve for reconstruction of oncologic amputation. TMR or RPNI are important new treatment adjuncts that should be considered during every amputation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
极高平面的下肢截肢是罕见的手术，需要进行大量的软组织和骨重建。本研究描述了使用鱼口皮瓣进行肿瘤重建，并采用靶向肌肉再支配（TMR）和再生周围神经接口（RPNI）预防慢性疼痛。
作者对2004年1月至2021年4月在MD安德森癌症中心接受下肢鱼口皮瓣手术的患者进行了回顾性研究。总结并比较手术结果。收集数字评分量表和患者报告的结局指标。
共进行了38例下肢重建的鱼口皮瓣手术。切除手术包括半侧骨盆切除术（42%）、半侧骨盆切除术联合骶骨切除术（32%）和转子上膝上截肢术（26%）。中位缺损面积为600平方厘米，50%的缺损包括骨成分。21例患者（55%）出现术后并发症，其中16例需要手术干预。术前接受放疗的患者并发症有增加趋势，但差异无统计学意义（44%对65%；P = 0.203）。7例患者接受了TMR或RPNI。在这些患者中，数字评分量表评估的残肢疼痛平均评分为2.8±3.4（n = 5；范围为0至4/10），幻肢疼痛评分为4±3.2（n = 6；范围为0至7/10）。患者报告结局指标信息系统的平均T评分为：疼痛强度50.8±10.6（n = 6；范围为30.7至60.5）；疼痛干扰59.2±12.1（n = 5；范围为40.7至70.1）；疼痛行为62.3±6.7（n = 3；范围为54.6至67.2）。
下肢鱼口皮瓣是肿瘤截肢重建中可靠的骨、软组织和神经来源。TMR或RPNI是重要的新型治疗辅助手段，在每次截肢手术时均应考虑。
临床问题/证据级别：治疗性研究，IV级。
