Ross D A, Lohman R F, Kroll S S, Yasko A W, Robb G L, Evans G R, Miller M J
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
Am J Surg. 1998 Jul;176(1):25-9. doi: 10.1016/s0002-9610(98)00101-9.
Resection of primary and metastatic pelvic bone disease may result in large soft tissue deficits. Guidelines for soft tissue reconstruction following pelvic bone resection were evaluated in a retrospective study.
Over a 5-year period 21 patients (31%) required soft tissue reconstruction following pelvic bone resection. Data on these patients were retrieved from case records.
Twelve patients underwent immediate, planned reconstruction, 1 a two-stage reconstruction, and 8 patients required a delayed procedure for complications after bone resection and primary closure. Soft tissue reconstruction was usually accomplished with muscle-based flaps; (25 flaps in 20 patients: 20 pedicled, 5 free), or with skin grafts alone (1 patient). Specific postreconstruction complications occurred in 9 patients, 5 in flaps based on the ipsilateral rectus muscle.
Flap closure is indicated to achieve primary closure and eliminate deadspace. The ipsilateral rectus muscle should be used with caution and contralateral-based rectus flaps considered. Indications for free flaps include the size and location of the defect and availability of tissue from an amputated limb.
原发性和转移性骨盆骨疾病的切除可能导致大面积软组织缺损。一项回顾性研究评估了骨盆骨切除术后软组织重建的指南。
在5年期间，21例患者（31%）在骨盆骨切除术后需要进行软组织重建。这些患者的数据从病例记录中获取。
12例患者接受了即时、计划性重建，1例接受了两阶段重建，8例患者因骨切除和一期缝合后的并发症需要延迟手术。软组织重建通常采用肌瓣（20例患者使用25个肌瓣：20个带蒂，5个游离），或仅采用皮肤移植（1例患者）。9例患者出现特定的重建后并发症，5例发生在同侧腹直肌瓣。
应采用皮瓣闭合以实现一期闭合并消除死腔。同侧腹直肌应谨慎使用，可考虑对侧腹直肌瓣。游离皮瓣的适应证包括缺损的大小和位置以及截肢肢体的组织可用性。
