Cordeiro P G, Neves R I, Hidalgo D A
Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Ann Plast Surg. 1994 Jul;33(1):9-16. doi: 10.1097/00000637-199407000-00003.
The current treatment of extremity sarcomas is multimodal, consisting of limb-sparing surgery, adjuvant radiotherapy, and/or chemotherapy. This approach has decreased the need for amputations and increased the demand for coverage of large composite defects. To date, the role of microsurgery in lower extremity reconstruction after oncologic resection has not been well defined. This study reviews a single center's experience with free tissue transfer for reconstruction of the lower extremity after oncologic resection. Fifty-nine free flaps were performed in 57 patients over a 5-year period. Forty-six patients (78%) underwent primary reconstruction and 35 patients (61%) received adjuvant therapy. Overall flap success rate was 96.6%. Most flaps were soft-tissue types including musculocutaneous (78%), skin only (11%), and muscle plus skin graft (4%). Osteocutaneous flaps were uncommon. There were major complications in 12% and minor complications in 7%. This study demonstrates that free tissue transfer for lower extremity reconstruction following oncologic resection has a high success rate that is similar to other free flap applications. It has become an integral part of lower extremity sarcoma management. Free flaps permit uninterrupted adjuvant therapy and enhance the efficacy of limb salvage surgery.
目前肢体肉瘤的治疗是多模式的，包括保肢手术、辅助放疗和/或化疗。这种方法减少了截肢的需求，并增加了对大型复合缺损修复的需求。迄今为止，显微外科手术在肿瘤切除术后下肢重建中的作用尚未明确界定。本研究回顾了单一中心在肿瘤切除术后采用游离组织移植进行下肢重建的经验。在5年期间，对57例患者进行了59次游离皮瓣移植。46例患者（78%）接受了一期重建，35例患者（61%）接受了辅助治疗。皮瓣总体成功率为96.6%。大多数皮瓣为软组织类型，包括肌皮瓣（78%）、单纯皮瓣（11%）和肌肉加植皮瓣（4%）。骨皮瓣不常见。主要并发症发生率为12%，次要并发症发生率为7%。本研究表明，肿瘤切除术后采用游离组织移植进行下肢重建成功率很高，与其他游离皮瓣应用相似。它已成为下肢肉瘤治疗不可或缺的一部分。游离皮瓣允许不间断地进行辅助治疗，并提高保肢手术的疗效。
