Serletti J M, Carras A J, O'Keefe R J, Rosier R N
The Cancer Center, and Department of Surgery, University of Rochester Medical Center, NY 14642, USA.
Plast Reconstr Surg. 1998 Oct;102(5):1576-83; discussion 1584-5. doi: 10.1097/00006534-199810000-00036.
Limb salvage has been achieved for patients with sarcoma by means of compartmental resection, soft-tissue reconstruction, and adjuvant therapy without increased rates of local recurrence, metastasis, or mortality. Despite the prevalence of limb salvage procedures in the treatment of these tumors, relatively little information has been published regarding late functional results in these reconstructed extremities. This study reports on the functional outcome for soft-tissue reconstruction for limb salvage in patients with sarcoma. Over the past 6 years, 28 patients were treated for sarcomas of the extremity in which soft-tissue reconstruction was needed for complete limb salvage. The mean age of these patients was 48 years (range, 14 to 83 years); there were 14 male and 14 female patients. Of the 28 sarcomas, 23 cases involved the lower extremity and 5 cases were in the upper extremity. Reconstruction was performed primarily in 12 patients; 16 reconstructions were performed secondarily because of wound complications after initial extirpation. Adjuvant radiation therapy was administered either preoperatively or postoperatively in all cases. Of the 33 reconstructive procedures performed in these 28 patients, 16 involved free flaps and 17 involved local flaps. All patients achieved initial limb salvage after the reconstructive procedure(s). Mean follow-up was 38 months. Twenty patients were available for the evaluation portion of the study. Two patients had delayed amputations: one for recurrent disease and another for osteoradionecrosis. Two patients died before beginning the examination process: one patient from the sarcoma and another patient from colon cancer. Twenty of the remaining 24 patients agreed to participate and were examined using the Enneking outcome measurement scale. Patients were examined for range of motion, deformity, stability, pain level, strength, functional activity, and emotional acceptance and assigned a numerical score for each category. Based on this, an overall rating of excellent, good, fair, or poor was assigned. Nine patients (45 percent) achieved an overall rating of excellent, five patients (25 percent) achieved a rating of good, and six patients (30 percent) achieved a fair score. None had received a rating of poor. There were no differences in the results obtained comparing upper versus lower extremity, immediate versus delayed reconstruction, or reconstructions performed with a free flap versus a pedicled flap. This study supports the continued use of soft-tissue reconstruction for limb salvage in sarcoma surgery with good to excellent late functional results obtained in the majority of patients.
通过间室切除、软组织重建和辅助治疗，肢体肉瘤患者已实现保肢，且局部复发、转移或死亡率未增加。尽管保肢手术在这些肿瘤的治疗中很普遍，但关于这些重建肢体的晚期功能结果的报道相对较少。本研究报告了肉瘤患者保肢软组织重建的功能结果。在过去6年中，28例肢体肉瘤患者接受了治疗，为实现完全保肢需要进行软组织重建。这些患者的平均年龄为48岁（范围14至83岁）；男、女患者各14例。28例肉瘤中，23例累及下肢，5例在上肢。12例患者主要进行了重建；16例因初次切除术后伤口并发症而进行了二次重建。所有病例均在术前或术后给予辅助放疗。在这28例患者中进行的33例重建手术中，16例采用游离皮瓣，17例采用局部皮瓣。所有患者在重建手术后均初步实现了保肢。平均随访38个月。20例患者可用于研究的评估部分。2例患者延迟截肢：1例因疾病复发，另1例因放射性骨坏死。2例患者在开始检查过程前死亡：1例死于肉瘤，另1例死于结肠癌。其余24例患者中有20例同意参与，并使用Enneking结果测量量表进行检查。对患者进行活动范围、畸形、稳定性、疼痛程度、力量、功能活动和情感接受度检查，并为每个类别赋予一个数字评分。据此，给出优秀、良好、中等或差的总体评分。9例患者（45%）获得优秀的总体评分，5例患者（25%）获得良好评分，6例患者（30%）获得中等评分。无人获得差的评分。比较上肢与下肢、即刻重建与延迟重建、游离皮瓣与带蒂皮瓣重建的结果无差异。本研究支持在肉瘤手术中继续使用软组织重建进行保肢，大多数患者获得了良好至优秀的晚期功能结果。
