Brunetti Beniamino, Salzillo Rosa, De Bernardis Riccardo, Petrucci Valeria, Pazzaglia Matteo, Camilloni Chiara, Putti Alessandra, Morelli Coppola Marco, Tenna Stefania, Persichetti Paolo
Department of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy.
J Clin Med. 2024 Jun 20;13(12):3622. doi: 10.3390/jcm13123622.
Sarcoma resection often leaves patients with big defects only amenable through microsurgical reconstruction. In such cases, it is hard for the surgeon to uphold low donor-site morbidity with an aesthetic result. The purpose of this study was to investigate the clinical outcome and the patient's perception regarding the donor site in a cohort of patients undergoing microsurgical reconstruction with lateral thigh and lower abdominal perforator flaps. A retrospective evaluation of all patients who underwent sarcoma reconstruction with flaps harvested from the lower abdominal region (deep inferior epigastric artery perforator flap, superficial circumflex iliac artery perforator flap) or lateral thigh region (anterolateral thigh perforator flap and its variations) was performed. Only patients with defects greater than 100 cm were included. Patient demographics and operative variables were recorded, together with complications. Patient satisfaction and quality of life with the donor site were registered using the SCAR-Q questionnaire, which was administered at least six months post-operatively. Eighteen anterolateral thigh (ALT) perforator flaps and twenty-two deep inferior epigastric artery perforator (DIEP) and superficial circumflex iliac artery perforator (SCIP) flap procedures were performed. The two groups were homogeneous for major post-operative complications ( > 0.999). Patient satisfaction with the donor site measured using the SCAR-Q questionnaire showed significantly higher scores in the DIEP/SCIP group when compared with the thigh group ( < 0.001), indicating a superiority of the lower abdominal area as an aesthetic donor site. The DIEP and SCIP flaps are a versatile option for reconstructing large soft-tissue defects following sarcoma resection. Therefore, flaps harvested from the lower abdomen yield a higher patient satisfaction with the donor site, which is a feature worth considering when planning a reconstructive procedure.
肉瘤切除术后常使患者留下大的缺损，仅能通过显微外科重建来修复。在此类情况下，外科医生很难在保证供区并发症发生率低的同时获得美观的效果。本研究的目的是调查一组接受大腿外侧和下腹部穿支皮瓣显微外科重建的患者的临床结局以及患者对供区的看法。对所有采用下腹部区域（腹壁下深动脉穿支皮瓣、旋髂浅动脉穿支皮瓣）或大腿外侧区域（股前外侧穿支皮瓣及其变异皮瓣）切取的皮瓣进行肉瘤重建的患者进行了回顾性评估。仅纳入缺损大于100平方厘米的患者。记录患者的人口统计学资料和手术变量以及并发症情况。使用SCAR-Q问卷记录患者对供区的满意度和生活质量，该问卷在术后至少6个月进行发放。共进行了18例股前外侧（ALT）穿支皮瓣手术以及22例腹壁下深动脉穿支（DIEP）和旋髂浅动脉穿支（SCIP）皮瓣手术。两组在主要术后并发症方面具有同质性（>0.999）。使用SCAR-Q问卷测得的患者对供区的满意度显示，DIEP/SCIP组的得分显著高于大腿组（<0.001），表明下腹部区域作为美观的供区具有优势。DIEP和SCIP皮瓣是肉瘤切除术后重建大型软组织缺损的一种通用选择。因此，取自下腹部的皮瓣能使患者对供区的满意度更高，这是在规划重建手术时值得考虑的一个特点。
