Meretsky Christopher R, Krumbach Brandon, Popovich Jay, Ajebli Mohammed, Schiuma Anthony T
Surgery, St. George's University School of Medicine, Great River, USA.
Anatomy, St. George's University, Great River, USA.
Cureus. 2024 Jul 10;16(7):e64258. doi: 10.7759/cureus.64258. eCollection 2024 Jul.
Osteosarcoma (OS), the most prevalent form of bone cancer, typically arises in osteoblast cells responsible for generating new bone. The bone produced by these cancer cells is weaker compared to healthy bone. OS is an aggressive bone cancer that often requires extensive resection, leaving behind substantial soft tissue defects. Successful closure after tumor excision is critical for wound healing and postoperative recovery. However, the optimal approach varies depending on factors like defect size and location. After extensive resection of OS, restoring the integrity of the affected area demands careful closure of both the skin and underlying muscle. The appropriate closure technique depends on the size and location of the soft tissue defect. The main objective of this systematic review is to evaluate and compare different surgical techniques for closing skin and muscle layers following large-scale OS removal. Through a systematic review methodology, we conducted an extensive analysis of the existing body of literature on this topic, drawing from relevant research papers published over the past two decades. This allowed us to collectively evaluate and synthesize available data on the subject. This review found that negative pressure wound therapy (NPWT) and flap reconstruction are the main surgical approaches used to close skin and muscle following extensive OS resection, which commonly results in large soft tissue defects due to the nature of tumor removal. Furthermore, NPWT was the most widely used method for closing soft tissue defects after major OS removal, while flap reconstruction was also common when NPWT was not appropriate or the defect was too large. An integrated approach combining vacuum therapy, skin stretching, and occasional flaps seeks to primarily close large defects after OS resection through optimized healing and tension reduction to achieve the best postoperative results.
骨肉瘤（OS）是最常见的骨癌形式，通常起源于负责生成新骨的成骨细胞。与健康骨骼相比，这些癌细胞生成的骨骼更脆弱。骨肉瘤是一种侵袭性骨癌，常常需要进行广泛切除，从而留下大量软组织缺损。肿瘤切除后的成功闭合对于伤口愈合和术后恢复至关重要。然而，最佳方法因缺损大小和位置等因素而异。在骨肉瘤广泛切除后，恢复受影响区域的完整性需要仔细闭合皮肤和深层肌肉。合适的闭合技术取决于软组织缺损的大小和位置。本系统评价的主要目的是评估和比较在大规模骨肉瘤切除后闭合皮肤和肌肉层的不同手术技术。通过系统评价方法，我们对过去二十年发表的相关研究论文中关于该主题的现有文献进行了广泛分析。这使我们能够共同评估和综合该主题的现有数据。该评价发现，负压伤口治疗（NPWT）和皮瓣重建是骨肉瘤广泛切除后用于闭合皮肤和肌肉的主要手术方法，由于肿瘤切除的性质，这通常会导致较大的软组织缺损。此外，NPWT是骨肉瘤主要切除后闭合软组织缺损最广泛使用的方法，而当NPWT不合适或缺损太大时，皮瓣重建也很常见。一种结合真空治疗、皮肤拉伸和偶尔使用皮瓣的综合方法旨在通过优化愈合和减轻张力，主要闭合骨肉瘤切除后的大缺损，以获得最佳术后效果。
