小腿肿瘤保肢术皮肤缺损的修复

The Safe Reliability of Two Kinds of Flap to Repair the Skin Defects in the Tumorous Limb Salvage Operation

目的 :比较游离皮瓣和局部皮瓣转移对于肢体肿瘤保肢术中皮缺损修复的安全性。方法 :1995年 9月～1999年 10月 ,分别用游离皮瓣移植和局部皮瓣转移修复 15例小腿恶性骨肿瘤和软组织肿瘤保肢术后形成的皮缺损 ,9例游离皮瓣移植 ,6例局部旋转皮瓣。结果 :游离皮瓣移植切口均一期愈合 ,无感染、皮瓣坏死 ,化疗对游离皮瓣成活无影响。 6例局部皮瓣 3例在术后 5d出现皮瓣循环障碍 ,皮瓣坏死 ,伤口开裂 ,灭活的肿瘤骨外露。结论 :小腿肿瘤保肢治疗中 ,采用局部皮瓣安全性较差。

Objective: To compare the safe reliability of two sorts of flap to repair the skin defect in the limb salvage operation of malignant tumor of lower extremity. Methods: A single center's experience with free flap and local random flap for reconstruction of the lower extremity after oncologic resection were retrospected. From Sep. 1995 to Oct. 1998, 15 cases of limb salvage operation of malignant bone tumor and soft tissue tumor of lower extremity with skin involvement were performed. Nine of the cases received the free radial arterial musculocutaneous flaps(3 cases), the peroneal cutaneous flaps(4 cases) and lateral femoral musculocutaneous flaps(2 cases). The skin defect of 6 cases was restored with the local rotational flaps. 9 cases of the free flap transfer healed in time with no complications, whereas, 3 cases of the local rotation flaps necrosed, which led to the exposure of the devitalized bone and internal fixation and retarded the patient's convalescent. Conclusions: This study demonstrates that free tissue transfer for lower extremity reconstruction following oncologic resection has a higher success rate than the local random flap applications and takes as an integral part in lower extremity sarcoma management.