Aluisio F V, Mair S D, Hall R L
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Foot Ankle Int. 1996 Nov;17(11):672-8. doi: 10.1177/107110079601701105.
Plantar fibromatosis is a benign but often problematic foot disorder which, when surgically treated, is difficult to eradicate. The purpose of this investigation was to identify epidemiologic factors associated with disease recurrence and to determine which method of treatment most successfully eliminated recurrence. A retrospective review of surgical pathology reports and clinical histories from 1979 to 1993 was performed to identify all patients who underwent surgery for plantar fibromatosis at our institution during that time. Thirty-three feet of 30 patients were identified with a minimum 2-year follow-up. Seventeen feet underwent surgery for primary lesions, and 4 of 10 that had local excision, 1 of 3 that had wide excision, and 2 of 4 that had subtotal fasciectomy (with or without skin grafting) had recurrence. All 16 feet in patients presenting with recurrent lesions had undergone prior local excision at other institutions. When combined with patients from our institution who underwent a second procedure, 21 feet had surgery for recurrent plantar fibromatosis. Of these, three of four had further recurrence when treated with local or wide excision. In feet with recurrences treated with subtotal fasciectomy, only 4 of 17 had recurrence after the first attempt at such treatment. Average follow-up for all patients was 7.7 years, and all patients with postoperative recurrences showed evidence of disease within 14 months after surgery (mean, 6.9 months). Factors identified with an increased risk for recurrence were multiple nodules, bilateral lesions, and positive family history. In treating recurrent disease, subtotal fasciectomy was more effective than local or wide excision. This study identified factors associated with a significant likelihood of postoperative recurrence in treating plantar fibromatosis and found subtotal fasciectomy to provide the most successful treatment in eradicating disease in recurrent cases.
足底纤维瘤病是一种良性但通常颇具问题的足部疾病，手术治疗时难以根除。本研究的目的是确定与疾病复发相关的流行病学因素，并确定哪种治疗方法能最成功地消除复发。对1979年至1993年的手术病理报告和临床病史进行了回顾性分析，以确定在此期间在我们机构接受足底纤维瘤病手术的所有患者。确定了30例患者的33只脚，进行了至少2年的随访。17只脚因原发性病变接受手术，10例行局部切除的患者中有4例复发，3例行广泛切除的患者中有1例复发，4例行次全筋膜切除术（伴或不伴植皮）的患者中有2例复发。所有16例出现复发病变的患者在其他机构均曾接受过局部切除。将我们机构接受二次手术的患者纳入后，21只脚因复发性足底纤维瘤病接受了手术。其中，4例接受局部或广泛切除治疗的患者中有3例进一步复发。在接受次全筋膜切除术治疗复发的病例中，首次尝试这种治疗后，17例中只有4例复发。所有患者的平均随访时间为7.7年，所有术后复发的患者在术后14个月内均有疾病复发迹象（平均6.9个月）。确定与复发风险增加相关的因素为多发结节（多个结节）、双侧病变和阳性家族史。在治疗复发性疾病时，次全筋膜切除术比局部或广泛切除更有效。本研究确定了在治疗足底纤维瘤病时与术后复发可能性显著相关的因素，并发现次全筋膜切除术在根除复发病例中的疾病方面提供了最成功的治疗方法。
