Memorial Sloan Kettering Cancer Center, Plastic and Reconstructive Surgery Service, New York, New York, USA.
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Microsurgery. 2024 Jan;44(1):e31130. doi: 10.1002/micr.31130. Epub 2023 Oct 25.
Limb salvage has become the standard of care for lower extremity tumors because of improvements in adjuvant treatments and reconstructive techniques. While there is literature assessing pediatric lower extremity free flap reconstruction in the setting of trauma, there is a paucity of literature that analyzes oncologic free flap reconstruction in this patient population. We report our long-term experience and evolution of care for lower extremity oncologic free flap reconstruction in pediatric patients.
This is a retrospective case series of all patients ≤18 years of age who underwent oncologic soft-tissue microvascular reconstruction of the lower extremity, from 1992 to 2021. Data were collected for patient demographics, oncologic treatment, operative details, and post-operative outcomes. Functional outcomes were assessed by weight bearing status, ambulation, and participation in activities-of-daily-living (ADLs), and musculoskeletal tumor society (MSTS) scores.
Over the 30-year study period, inclusion criteria were met by 19 patients (11 males, 8 females) with a mean age of 13.8 years and a mean follow-up of 5.3 years. At last follow-up, 13 patients (68.5%) were alive. The most common pathology was osteogenic sarcoma (13 patients, 68.5%). Sites of reconstruction were the hip (n = 1), thigh (n = 5), knee (n = 4), leg (n = 7), and the foot (n = 2). The most commonly used flaps were latissimus dorsi (n = 8), gracilis (n = 4), and anterolateral thigh ± vastus (n = 4). Postoperative complications occurred in nine patients (43%). Overall flap success rate was 95%. At latest follow-up, ambulation without assistive device was obtained in 11 patients (58%), full weight bearing was achieved by 13 patients (68.5%), and ADLs could be performed independently by 13 patients (68.5%). Mean MSTS score was 23.1/30.
Microvascular reconstruction for oncological lower extremity defects in the pediatric population has high limb salvage rates and good functional outcomes.
由于辅助治疗和重建技术的进步，保肢已成为下肢肿瘤的标准治疗方法。虽然有文献评估了创伤背景下儿童下肢游离皮瓣重建，但在该患者群体中，关于肿瘤游离皮瓣重建的文献很少。我们报告了我们在儿童下肢肿瘤游离皮瓣重建方面的长期经验和治疗进展。
这是一项回顾性病例系列研究，纳入了 1992 年至 2021 年间所有接受下肢骨肿瘤软组织微血管重建的≤18 岁患者。收集患者的人口统计学、肿瘤治疗、手术细节和术后结果数据。通过负重状态、行走和日常生活活动（ADL）参与以及肌肉骨骼肿瘤学会（MSTS）评分来评估功能结果。
在 30 年的研究期间，符合纳入标准的有 19 名患者（男性 11 名，女性 8 名），平均年龄为 13.8 岁，平均随访 5.3 年。最后一次随访时，13 名患者（68.5%）存活。最常见的病理类型是骨肉瘤（13 例，68.5%）。重建部位包括髋关节（n=1）、大腿（n=5）、膝关节（n=4）、小腿（n=7）和足部（n=2）。最常使用的皮瓣是背阔肌（n=8）、股薄肌（n=4）和前外侧大腿+股四头肌（n=4）。9 名患者（43%）发生术后并发症。总的皮瓣成活率为 95%。最新随访时，11 名患者（58%）无需辅助设备即可行走，13 名患者（68.5%）完全负重，13 名患者（68.5%）可独立完成 ADL。平均 MSTS 评分为 23.1/30。
儿童下肢肿瘤缺损的微血管重建具有较高的保肢率和良好的功能结果。
