Pinto Valentina, Zeneli Flavia, di Summa Pietro Giovanni, Sapino Gianluca, Donati Davide Maria, Bernagozzi Fabio, Cipriani Riccardo, De Santis Giorgio, Pignatti Marco
Plastic Surgery, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 71, 41125 Modena, Italy.
Department of Medical and Surgical Sciences (SMECHIMAI), University of Modena and Reggio Emilia, 41121 Modena, Italy.
Healthcare (Basel). 2024 Oct 15;12(20):2043. doi: 10.3390/healthcare12202043.
The choice of the most adequate surgical technique for upper limb defects remains challenging. The aim of this article is to discuss the main microsurgical (pedicled or free) reconstructive options for the post-oncological reconstruction of different anatomical areas of the upper extremity.
We reviewed different reconstructive methods reported in the literature needing microsurgical expertise and compared them to our clinical experience, in order to provide further guidance in the choice of different flaps for upper limb soft tissue reconstruction. Six clinical cases, one for each anatomical district, are presented as examples of possible solutions.
We report the options available in the literature for post-oncologic upper limb reconstruction, dividing them by anatomical area and type of flap: local flaps, regional flaps, free flaps, and distant pedicled flaps. Our examples of the reconstruction of each anatomical area of the upper limb include one reverse ulnar pedicled perforator flap, one free Antero-Lateral Thigh (ALT) flow-through flap, one perforator-based lateral arm flap, two myocutaneous latissimus dorsi pedicled flaps, and one parascapular perforator-plus flap.
In oncological cases, it is important to consider reconstructive options that provide stable tissue and allow for the early healing of the donor and recipient site if the patient needs to undergo adjuvant radiotherapy or chemotherapy. A wider range of flap options is essential when choosing the proper technique according to the patient's needs, surgeon's preference, and logistical possibilities. Perforator flaps combine the advantages of other flaps, but they require microsurgical expertise. Free flap reconstruction remains the gold standard to obtain a better overall and cosmetic outcome in complex and wide defects, where no suitable local pedicled flap option exists. The pedicled latissimus dorsi flap should still be included among the reconstructive options for its strong vascularization, size, and arc of transposition.
为上肢缺损选择最合适的手术技术仍然具有挑战性。本文旨在探讨上肢不同解剖区域肿瘤切除术后重建的主要显微外科（带蒂或游离）重建方案。
我们回顾了文献中报道的需要显微外科专业知识的不同重建方法，并将其与我们的临床经验进行比较，以便为上肢软组织重建中不同皮瓣的选择提供进一步指导。本文展示了六个临床病例，每个解剖区域一个，作为可能解决方案的示例。
我们报告了文献中可用于上肢肿瘤切除术后重建的方案，根据解剖区域和皮瓣类型进行划分：局部皮瓣、区域皮瓣、游离皮瓣和远位带蒂皮瓣。我们上肢各解剖区域重建的示例包括一个尺侧逆行穿支皮瓣、一个游离股前外侧（ALT）穿通皮瓣、一个基于穿支的上臂外侧皮瓣、两个背阔肌肌皮瓣和一个肩胛旁穿支加皮瓣。
在肿瘤病例中，如果患者需要接受辅助放疗或化疗，重要的是要考虑提供稳定组织并能使供区和受区早期愈合的重建方案。根据患者需求、外科医生偏好和后勤可能性选择合适技术时，更广泛的皮瓣选择至关重要。穿支皮瓣兼具其他皮瓣的优点，但需要显微外科专业知识。在不存在合适的局部带蒂皮瓣选择的复杂和广泛缺损中，游离皮瓣重建仍然是获得更好的整体和美容效果的金标准。由于其强大的血供、大小和移位弧度，带蒂背阔肌皮瓣仍应作为重建方案之一。
