Abramson D L, Orgill D P, Singer S, Gibstein L A, Pribaz J J
Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Ann Plast Surg. 1997 Nov;39(5):454-60. doi: 10.1097/00000637-199711000-00003.
The present study describes the techniques available for single-stage sarcoma resection, soft-tissue reconstruction, and radiotherapy for limb preservation in patients who are unable to undergo primary wound closure after a complete soft-tissue resection of their primary sarcoma. From 1989 to 1994, 19 patients (age range, 18-79 years; mean, 51.2 years) underwent radical resection of extremity sarcomas followed by immediate reconstruction. Seven patients had tumors in the upper extremity and 12 patients had tumors in the lower extremity. There were 13 primary tumors and 6 recurrent tumors. Fifteen patients (79%) received radiation therapy, 7 patients by external beam and 8 patients by brachytherapy. Reconstruction included 16 regional flaps in 13 patients and 7 free tissue transfers in 6 patients. Commonly used flaps included the rectus abdominis (N = 5), the latissimus dorsi (N = 4), the anterolateral thigh (N = 4), the reverse-flow radial forearm (N = 2), and the gastrocnemius (N = 2) flaps. Complications included wound breakdown (N = 2), partial skin graft failure (N = 1), hematoma requiring operative evacuation (N = 1), and partial flap necrosis (N = 1). There were no operative mortalities. Eight patients underwent wide local excision, flap closure, and brachytherapy. Mean length of hospital stay for this group was 12.3 days compared with 13.8 days for the remaining 11 patients. There was one complication (13%) in this group and four complications in the remaining patients (4 of 11; 36%). Our study confirms the utility of soft-tissue reconstruction to permit wide local excision with clear margins as well as the delivery of postoperative radiotherapy. It demonstrates the ability of pedicled flaps and free tissue transfers to remain viable and provide sufficient wound coverage in the setting of early postoperative brachytherapy. In addition, this series illustrates the efficacy of a team approach and one-stage therapy for extremity soft-tissue sarcomas that includes excision, reconstruction, and early postoperative brachytherapy in a single hospitalization.
本研究描述了对于原发性肉瘤进行完全软组织切除后无法进行一期伤口闭合的患者，可采用的肢体保留单阶段肉瘤切除、软组织重建及放射治疗技术。1989年至1994年，19例患者（年龄范围18 - 79岁；平均51.2岁）接受了肢体肉瘤根治性切除并立即进行重建。7例患者肿瘤位于上肢，12例患者肿瘤位于下肢。有13例原发性肿瘤和6例复发性肿瘤。15例患者（79%）接受了放射治疗，7例接受外照射，8例接受近距离放射治疗。重建包括13例患者使用16个局部皮瓣和6例患者使用7个游离组织移植。常用皮瓣包括腹直肌皮瓣（N = 5）、背阔肌皮瓣（N = 4）、股前外侧皮瓣（N = 4）、逆行桡侧前臂皮瓣（N = 2）和腓肠肌皮瓣（N = 2）。并发症包括伤口裂开（N = 2）、部分皮肤移植失败（N = 1）、需手术引流的血肿（N = 1）和部分皮瓣坏死（N = 1）。无手术死亡病例。8例患者接受了广泛局部切除、皮瓣闭合及近距离放射治疗。该组患者平均住院时间为12.3天，其余11例患者为13.8天。该组有1例并发症（13%），其余患者有4例并发症（11例中的4例；36%）。我们的研究证实了软组织重建对于实现具有清晰切缘的广泛局部切除以及术后放射治疗的实用性。它证明了在术后早期近距离放射治疗的情况下，带蒂皮瓣和游离组织移植能够存活并提供足够的伤口覆盖。此外，本系列研究说明了对于肢体软组织肉瘤采用团队协作方法及单阶段治疗的有效性，该方法包括在一次住院期间进行切除、重建及术后早期近距离放射治疗。
