Department of Plastic and Reconstructive Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Spine Center, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Microsurgery. 2024 Jan;44(1):e31103. doi: 10.1002/micr.31103. Epub 2023 Aug 28.
Excision of sacral tumor results in extensive defects and vital organ exposure, requiring soft tissue reconstruction for dead space obliteration. Diverse reconstruction options, mainly regional flaps, have been utilized but are limited by high postoperative morbidity. A reliable reconstructive method with low morbidity and facilitated recovery has yet been sought for. In this study, we aimed to evaluate the use of free latissimus dorsi (LD) flap for post-sacrectomy defect reconstruction by comparing its outcomes with local gluteus maximus (GM) flap.
A retrospective review was conducted of all patients with sacral malignancy who underwent partial or total sacrectomy and immediate reconstruction with LD or GM flap between 2013 and 2022. Nineteen patients were analyzed, including 10 GM flaps and nine LD flaps. Postoperative outcomes were compared between the two groups.
The average size of LD flaps was 173.8 cm . Seven patients developed complication in the GM group and two patients in the LD group. Complication rate at sacrectomy site was lower in the LD group (p = .003) showing complication-free sacrectomy site and two donor site seromas. The LD group resulted in shorter hospital stay (p = .033) and earlier ambulation than the GM group (p = .001). Mean follow-up period was 63 months for GM group and 17 months for LD group. Three patients in the GM group underwent re-operation, while no delayed complication was observed in the LD group.
Free LD flaps may provide reliable outcomes with early recovery and may be considered an effective option for sacrectomy defect reconstruction.
切除骶骨肿瘤会导致广泛的缺损和重要器官暴露，需要软组织重建以消灭死腔。已经使用了多种重建方法，主要是区域性皮瓣，但术后发病率高，受到限制。目前仍在寻求一种发病率低、恢复方便的可靠重建方法。本研究旨在通过比较游离背阔肌（LD）皮瓣和局部臀大肌（GM）皮瓣在骶骨肿瘤切除术后缺损重建中的应用效果，评估游离背阔肌皮瓣在该部位的应用。
回顾性分析了 2013 年至 2022 年间接受部分或全骶骨切除术并立即采用 LD 或 GM 皮瓣重建的骶骨恶性肿瘤患者的所有病例。分析了 19 例患者，包括 10 例 GM 皮瓣和 9 例 LD 皮瓣。比较两组患者的术后结果。
LD 皮瓣的平均大小为 173.8cm。GM 组 7 例患者出现并发症，LD 组 2 例患者出现并发症。LD 组的骶骨切除部位并发症发生率较低（p=0.003），表现为骶骨切除部位无并发症和两个供区血清肿。LD 组的住院时间较短（p=0.033），早期下床活动（p=0.001）。GM 组的平均随访时间为 63 个月，LD 组为 17 个月。GM 组 3 例患者行二次手术，LD 组无延迟并发症发生。
游离背阔肌皮瓣可为患者提供可靠的结果，并能尽早恢复，可作为骶骨肿瘤切除术后缺损重建的有效选择。
