軟組織重建在骨與軟組織腫瘤外科治療中的應用_《中國修復重建外科雜志》

作者：

姬濤 ¹ , 王天兵 ² , 郭衛 ¹

北京大學人民醫院（北京，100044）1骨與軟組織腫瘤治療中心，2創傷骨科;

關鍵詞：

骨與軟組織腫瘤軟組織重建保肢治療皮瓣

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目的回顧不同部位骨與軟組織腫瘤切除術后軟組織重建方法及臨床療效，探討合理的軟組織重建策略。方法2003年6月－2010年12月，收治因骨或軟組織腫瘤進行外科切除并接受皮瓣、肌瓣或肌皮瓣修復重建患者90例。其中男59例，女31例；年齡9～85歲，中位年齡37.2歲。骨原發或轉移性腫瘤52例，軟組織原發腫瘤38例。75例為腫瘤切除后一期軟組織重建；7例因傷口不愈合行清創后軟組織重建；8例因傷口感染行清創、負壓封閉引流，二期軟組織重建。皮瓣類型：腓腸肌肌瓣40例，背闊肌肌（皮）瓣6例，腹直肌肌（皮）瓣4例，臀大肌肌皮瓣、胸大肌肌瓣、交腹皮瓣各1例，局部轉移皮瓣27例，帶血管蒂皮瓣5例，單純游離植皮5例。皮瓣范圍為6.5 cm × 4.5 cm～21.0 cm × 9.0 cm。結果術后87例皮瓣成活；Ⅰ期愈合81例；Ⅱ期愈合6例，其中2例皮瓣部分壞死，經換藥后成活，3例皮瓣延遲愈合，1例傷口輕度感染，經保守治療后愈合。軟組織重建失敗3例，均為皮瓣壞死合并感染，經清創二次皮瓣轉移后愈合。供區創面均Ⅰ期愈合，移植皮片完全成活。73例獲隨訪，隨訪時間10～102個月，平均36.1個月。6例患者于術后2～27個月，平均8.2個月出現局部復發并接受二次手術切除。13例于術后6～34個月，平均19.2個月死于原發病。結論骨與軟組織腫瘤切除后常造成較大的軟組織缺損，選擇適當的肌（皮）瓣進行軟組織重建可以達到理想的傷口閉合，減少術后傷口并發癥，有利于術后功能恢復。

引用本文： 姬濤,王天兵,郭衛. 軟組織重建在骨與軟組織腫瘤外科治療中的應用. 中國修復重建外科雜志, 2012, 26(8): 950-954. doi: 復制

1.	Buchner M, Zeifang F, Bernd L. Medial gastrocnemius muscle flap in limb-sparing surgery of malignant bone tumors of the proximal tibia: mid-term results in 25 patients. Ann Plast Surg, 2003, 51(3): 266-272.
2.	Kramers-de Quervain IA, Läuffer JM, Käch K, et al. Functional donor-site morbidity during level and uphill gait after a gastrocnemius or soleus muscle-flap procedure. J Bone Joint Surg (Am), 2001, 83-A(2): 239-246.
3.	Davidge KM, Wunder J, Tomlinson G, et al. Function and health status outcomes following soft tissue reconstruction for limb preservation in extremity soft tissue sarcoma. Ann Surg Oncol, 2010, 17(4): 1052-1062.
4.	Moreira-Gonzalez A, Djohan R, Lohman R. Considerations surrounding reconstruction after resection of musculoskeletal sarcomas. Cleve Clin J Med, 2010, 77 Suppl 1: S18-22.
5.	Misra A, Mistry N, Grimer R, et al. The management of soft tissue sarcoma. J Plast Reconstr Aesthet Surg, 2009, 62(2): 161-174.
6.	Morii T, Mochizuki K, Takushima A, et al. Soft tissue reconstruction using vascularized tissue transplantation following resection of musculoskeletal sarcoma: evaluation of oncologic and functional outcomes in 55 cases. Ann Plast Surg, 2009, 62(3): 252-257.
7.	Heller L, Kronowitz SJ. Lower extremity reconstruction. J Surg Oncol, 2006, 94(6): 479-489.
8.	Heller L, Ballo MT, Cormier JN, et al. Staged reconstruction for resection wounds in sarcoma patients treated with brachytherapy. Ann Plast Surg, 2008, 60(1): 58-63.
9.	Evans GR, Black JJ, Robb GL, et al. Adjuvant therapy: the effects on microvascular lower extremity reconstruction. Ann Plast Surg, 1997, 39(2): 141-144.
10.	Peat BG, Bell RS, Davis A, et al. Wound-healing complications after soft-tissue sarcoma surgery. Plast Reconstr Surg, 1994, 93(5): 980-987.
11.	Barwick WJ, Goldberg JA, Scully SP, et al. Vascularized tissue transfer for closure of irradiated wounds after soft tissue sarcoma resection. Ann Surg, 1992, 216(5): 591-595.
12.	Kunisada T, Ngan SY, Powell G, et al. Wound complications following pre-operative radiotherapy for soft tissue sarcoma. Eur J Surg Oncol, 2002, 28(1): 75-79.
13.	Hamdi M, Spano A, Van Landuyt K, et al. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg, 2008, 121(2): 389-396.
14.	Chim H, Tan BK, Tan MH, et al. Optimizing the use of local muscle flaps for knee megaprosthesis coverage. Ann Plast Surg, 2007, 59(4): 398-403.
15.	Mastorakos DP, Disa JJ, Athanasian E, et al. Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction. Plast Reconstr Surg, 2002, 109(5): 1567-1573.
16.	Ver Halen JP, Yu P, Skoracki RJ, et al. Reconstruction of massive oncologic defects using free fillet flaps. Plast Reconstr Surg, 2010, 125(3): 913-922.
17.	Springfield D. Surgery for MSK tumors: 1971-2011. Skeletal Radiol, 2011, 40(9): 1233-1237.
18.	Yoshida S, Yokoyama R, Sakamoto A. Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap. Microsurgery, 2011, 31(8): 655-658.

1. Buchner M, Zeifang F, Bernd L. Medial gastrocnemius muscle flap in limb-sparing surgery of malignant bone tumors of the proximal tibia: mid-term results in 25 patients. Ann Plast Surg, 2003, 51(3): 266-272.
2. Kramers-de Quervain IA, Läuffer JM, Käch K, et al. Functional donor-site morbidity during level and uphill gait after a gastrocnemius or soleus muscle-flap procedure. J Bone Joint Surg (Am), 2001, 83-A(2): 239-246.
3. Davidge KM, Wunder J, Tomlinson G, et al. Function and health status outcomes following soft tissue reconstruction for limb preservation in extremity soft tissue sarcoma. Ann Surg Oncol, 2010, 17(4): 1052-1062.
4. Moreira-Gonzalez A, Djohan R, Lohman R. Considerations surrounding reconstruction after resection of musculoskeletal sarcomas. Cleve Clin J Med, 2010, 77 Suppl 1: S18-22.
5. Misra A, Mistry N, Grimer R, et al. The management of soft tissue sarcoma. J Plast Reconstr Aesthet Surg, 2009, 62(2): 161-174.
6. Morii T, Mochizuki K, Takushima A, et al. Soft tissue reconstruction using vascularized tissue transplantation following resection of musculoskeletal sarcoma: evaluation of oncologic and functional outcomes in 55 cases. Ann Plast Surg, 2009, 62(3): 252-257.
7. Heller L, Kronowitz SJ. Lower extremity reconstruction. J Surg Oncol, 2006, 94(6): 479-489.
8. Heller L, Ballo MT, Cormier JN, et al. Staged reconstruction for resection wounds in sarcoma patients treated with brachytherapy. Ann Plast Surg, 2008, 60(1): 58-63.
9. Evans GR, Black JJ, Robb GL, et al. Adjuvant therapy: the effects on microvascular lower extremity reconstruction. Ann Plast Surg, 1997, 39(2): 141-144.
10. Peat BG, Bell RS, Davis A, et al. Wound-healing complications after soft-tissue sarcoma surgery. Plast Reconstr Surg, 1994, 93(5): 980-987.
11. Barwick WJ, Goldberg JA, Scully SP, et al. Vascularized tissue transfer for closure of irradiated wounds after soft tissue sarcoma resection. Ann Surg, 1992, 216(5): 591-595.
12. Kunisada T, Ngan SY, Powell G, et al. Wound complications following pre-operative radiotherapy for soft tissue sarcoma. Eur J Surg Oncol, 2002, 28(1): 75-79.
13. Hamdi M, Spano A, Van Landuyt K, et al. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg, 2008, 121(2): 389-396.
14. Chim H, Tan BK, Tan MH, et al. Optimizing the use of local muscle flaps for knee megaprosthesis coverage. Ann Plast Surg, 2007, 59(4): 398-403.
15. Mastorakos DP, Disa JJ, Athanasian E, et al. Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction. Plast Reconstr Surg, 2002, 109(5): 1567-1573.
16. Ver Halen JP, Yu P, Skoracki RJ, et al. Reconstruction of massive oncologic defects using free fillet flaps. Plast Reconstr Surg, 2010, 125(3): 913-922.
17. Springfield D. Surgery for MSK tumors: 1971-2011. Skeletal Radiol, 2011, 40(9): 1233-1237.
18. Yoshida S, Yokoyama R, Sakamoto A. Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap. Microsurgery, 2011, 31(8): 655-658.

《中國修復重建外科雜志》

軟組織重建在骨與軟組織腫瘤外科治療中的應用

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《中國修復重建外科雜志》

軟組織重建在骨與軟組織腫瘤外科治療中的應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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