Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
Medicina (Kaunas). 2023 Aug 18;59(8):1489. doi: 10.3390/medicina59081489.
: Surgical management of local recurrence of soft tissue sarcomas (STS) is still challenging. In this article, we report on multiple flap reconstructions for multiple local recurrences of STS. Their feasibility will be validated by examining clinical cases. : Patients who underwent multiple flap reconstructions for multiple local recurrences of STS between April 1997 and October 2021 were included in this retrospective study. Patient demographics, tumor characteristics, surgical characteristics, and postoperative complications were examined. : Twenty operations of eight patients were identified. The location of the defects was the back in two, the buttock in two, the groin in two, and the lower extremities in two. The average total number of wide resections was 4.0 and the average total number of flap reconstructions was 2.5. The average follow-up period was 109.4 months. The average size of the defect was 102.4 cm and the average flap size was 15.7 × 10.8 cm. The histological diagnoses were malignant fibrous histocytoma (MFH) in eight operations, osteosarcoma in two operations, myxoid liposarcoma in two operations, undifferentiated pleomorphic sarcoma (UPS) in six operations, and myxofibrosarcoma (MFS) in one operation. Of twelve subsequent operations, the resection of the previously transferred flap was performed in six operations (50%). The occurrence of take back, flap complications, and donor-site complications in the primary operation group was 25%, 25%, and 12.5%, respectively. The occurrence of take back, flap complications, and donor-site complications in the second and subsequent operation group was 0%, 0%, and 16.7%, respectively. : Multiple operations including wide resections followed by flap reconstructions for multiple local recurrences are feasible. Reconstructive surgeons should choose the options of the flaps considering the future local recurrence for tumors with a high risk of recurrence.
: 软组织肉瘤（STS）局部复发的手术治疗仍然具有挑战性。本文报告了多例STS 多处局部复发的多种皮瓣重建。通过检查临床病例来验证其可行性。 : 本回顾性研究纳入了 1997 年 4 月至 2021 年 10 月期间因 STS 多处局部复发而行多种皮瓣重建的患者。检查了患者的人口统计学、肿瘤特征、手术特征和术后并发症。 : 确定了 8 名患者的 20 次手术。缺损部位为背部 2 例，臀部 2 例，腹股沟 2 例，下肢 2 例。平均广泛切除的总次数为 4.0 次，平均皮瓣重建的总次数为 2.5 次。平均随访时间为 109.4 个月。平均缺损大小为 102.4cm，平均皮瓣大小为 15.7×10.8cm。组织学诊断为 8 次手术为恶性纤维组织细胞瘤（MFH），2 次手术为骨肉瘤，2 次手术为黏液样脂肪肉瘤，6 次手术为未分化多形性肉瘤（UPS），1 次手术为黏液纤维肉瘤（MFS）。在随后的 12 次手术中，有 6 次手术（50%）切除了先前转移的皮瓣。在初次手术组中，皮瓣回缩、皮瓣并发症和供区并发症的发生率分别为 25%、25%和 12.5%。在第二次及以后手术组中，皮瓣回缩、皮瓣并发症和供区并发症的发生率分别为 0%、0%和 16.7%。 : 对于复发风险高的肿瘤，行多次广泛切除后行皮瓣重建治疗多处局部复发是可行的。重建外科医生应根据肿瘤的未来局部复发情况选择皮瓣方案。
