肌皮瓣修复关节周围软组织肉瘤组织缺损的临床研究  

Clinical study of peripheral musculocutaneous flap in repairing tissue defect of periarticular soft tissue sarcoma

作　　者：商冠宁[1] 孙平[1] 黄涛[2] 邢浩[1] 王玉名[1] 裴祎[1] 

机构地区：[1]辽宁省肿瘤医院骨软组织肿瘤科,辽宁沈阳110042 [2]中国医科大学附属第一医院骨科,辽宁沈阳110001

出　　处：《中国肿瘤外科杂志》2015年第1期9-13,共5页Chinese Journal of Surgical Oncology

基　　金：辽宁省科学技术计划项目(No.2013225021)

摘　　要：目的探讨系列肌皮瓣在肢体关节周围软组织肉瘤切除后组织缺损修复中的临床应用。方法肢体关节周围软组织肉瘤外科手术软组织缺损28例,其中初发7例,补充切除8例,复发13例。所有病例均行软组织肉瘤广泛切除肌皮瓣修复手术治疗,软组织缺损面积最大为26 cm×16 cm。依据不同部位设计修复所需肌皮瓣,应用背阔肌肌皮瓣修复肩部、股二头肌肌皮瓣修复髋部、腓肠肌肌皮瓣修复膝部。结果 28例中24例术后肌皮瓣成活,3例肌皮瓣远端边缘性坏死,1例远侧2/3坏死,经换药或植皮后愈合。平均随访38个月,有4例肿瘤局部复发,均为多次手术后复发患者,2例复发再次手术切除植皮,2例复发无法保肢行截肢手术治疗。移植肌皮瓣质地良好,皮肤色泽与受区相似,肌皮瓣血液循环良好,患肢关节恢复正常屈伸。结论肌皮瓣具有稳定的血供,易于切取和存活,修复肢体关节周围软组织肉瘤手术组织缺损同时改善肢体功能,为关节周围软组织肉瘤的外科规范化治疗提供了有益探索。Objective To investigate the clinical efficacy of the application of the various tissue flaps for repairing soft tissue defects around the limbs and joint after wide excision of soft tissue sarcoma. Methods Application of latissimus dorsi,biceps flexor cruris and gastrocnemius musculocutaneous flap to repair soft tissue defect of surgical operation in peripheral joints and limbs soft tissue sarcoma. There are 28 cases in this study,of which,7 cases of primary sarcoma,supplementary resection in 8 cases and recurrence in 13 cases. All patients underwent wide excision surgery. The soft tissue defect area of a maximum is 26 cm × 16 cm. Based on the different parts of soft tissue sarcomas,the wide excision defects need to be repaired with various tissue flaps in which the latissimus dorsi musculocutaneous flap to repair the shoulder,biceps femoris musculocutaneous flap to repair the hip and gastrocnemius musculocutaneous flap to repair the knee. Results The group of 24 cases of the various tissue flaps survived successfully. The flaps had distal marginal necrosis in 3 cases and distal 2 /3necrosis in 1 case which achieved secondary healing after dress changing and skin grafting. The average followup time was 38 months. 4 cases lived with multiple local recurrence,2 cases with recurrence after secondary excision and skin grafting and 2 cases with local recurrence were performed amputation without possibility of the salvage treatment. The transplanted muscle flap and blood circulation were good. Moreover,the skin color was similar to the affected area. Limb joints returned to normal flexion and extension. Conclusions The blood supply of muscle flap was stable and it was easy to cut and obtain. Application of various flaps to repair soft tissue defect in peri-joints and limbs after soft tissue sarcoma wide resection not only improved function but also provided a useful exploration of periarticular soft tissue sarcoma therapy.

关 键 词：肌皮瓣 软组织肉瘤 缺损 修复 

分 类 号：R738.6[医药卫生—肿瘤]