Zentrum für Plastische Chirurgie, Pyramid Clinic, Zurich, Switzerland.
Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Microsurgery. 2024 Sep;44(6):e31224. doi: 10.1002/micr.31224.
Soft-tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin and account for only 1% of adult malignancies. They tend to occur most commonly in the lower extremities. Reconstruction after sarcoma resection can be challenging, especially when important structures are involved and recurrences occur. Additionally, more attention is now being paid to reconstructing the lymphatic system to prevent lymphatic complications. In this case report, we presented the management of recurrent medial thigh sarcoma that necessitated multiple challenging reconstructions to provide valuable insights for lectures on similar cases. A 50-year-old male patient was diagnosed with an undifferentiated pleomorphic cell sarcoma (UPS) of the anteromedial thigh. After preoperative radiotherapy, a mass of 23 × 15 cm was removed, and reconstruction with a pedicled deep inferior epigastric artery perforator (p-DIEP) flap-based lymphatic flow through (LyFT) was performed. Six months later, the patient developed the first local recurrence with the presence of a distant metastasis. Following the tumor resection, the medial part of the DIEP flap was de-epithelized and buried in the defect for dead space obliteration. Another local recurrence arose 7 months after the second surgery. Therefore, a major debulking surgery involving the femoral neurovascular bundle was performed. The femoral artery was reconstructed with a synthetic graft, and the femoral vein with the great saphenous vein harvested from the contralateral thigh. A composite myocutaneous neurotized anterolateral thigh (ALT) flap from the contralateral thigh was used to obliterate the defect and restore the loss of function of the quadriceps femoris. Two lymphaticovenular anastomoses (LVAs) were performed at the ankle to reduce the risk of lymphatic sequelae. This case report highlights the importance of integrating various techniques to create a tailored approach that effectively addresses complex surgical requirements to avoid limb amputation and maintain functionality.
软组织肉瘤（STS）是一种罕见的源自间充质细胞的实体肿瘤，仅占成人恶性肿瘤的 1%。它们通常最常发生在下肢。肉瘤切除后的重建可能具有挑战性，特别是当涉及重要结构并且发生复发时。此外，现在更加关注重建淋巴管系统以预防淋巴并发症。在本病例报告中，我们介绍了复发性大腿内侧肉瘤的处理方法，这需要进行多次具有挑战性的重建，为类似病例的讲座提供了有价值的见解。一名 50 岁男性患者被诊断为大腿前内侧的未分化多形性细胞肉瘤（UPS）。术前放疗后，切除了 23×15cm 的肿块，并进行了带蒂深部腹壁下动脉穿支（p-DIEP）皮瓣淋巴管血流重建（LyFT）。6 个月后，患者出现了第一次局部复发，并出现远处转移。肿瘤切除后，DIEP 皮瓣的内侧部分去上皮化并埋入缺损处以消除死腔。第二次手术后 7 个月再次出现局部复发。因此，进行了涉及股神经血管束的大减瘤手术。使用来自对侧大腿的合成移植物重建股动脉，使用大隐静脉重建股静脉。使用来自对侧大腿的复合肌皮神经化前外侧大腿（ALT）皮瓣来填充缺损并恢复股四头肌的功能丧失。在踝关节处进行了 2 个淋巴静脉吻合术（LVA）以降低淋巴后遗症的风险。本病例报告强调了整合各种技术以创建量身定制的方法的重要性，该方法可以有效地满足复杂的手术要求，避免截肢并保持功能。
