腓肠肌肌皮瓣在修复膝关节周围软组织肉瘤手术组织缺损中的应用

目的探讨应用腓肠肌肌皮瓣修复膝关节周围软组织肉瘤广泛切除术软组织缺损的临床疗效。方法回顾性分析2009年3月至2012年5月有完整随访资料的膝关节周围软组织肉瘤患者的临床资料。所有病例均行软组织肉瘤广泛切除手术,并依据不同部位及缺损范围设计应用腓肠肌肌皮瓣修复软组织肉瘤广泛切除后的软组织缺损。结果全组12例,手术过程顺利,腓肠肌肌皮瓣均顺利成活。术后随访3—39个月,平均15个月,全组病例无复发,其中1例滑膜肉瘤术后8个月出现肺转移,均无死亡。移植肌皮瓣质地好,皮肤色泽与受区相似,其中4例蒂部外观略显臃肿,其余外形及功能恢复均良好,膝关节屈伸无受限。肌皮瓣供区小腿运动功能无影响,供区瘢痕位置隐蔽,无明显挛缩。结论腓肠肌肌皮瓣血管恒定,术中操作简单,成活率高,是修复膝关节周围软组织肉瘤广泛切除术后软组织缺损的良好选择。     

带蒂肌皮瓣在肢体软组织肉瘤术中皮肤缺损修复中的临床应用

目的：探讨带蒂肌皮瓣在肢体软组织肉瘤术中皮肤和肌肉创面缺损修复中的临床应用。方法回顾性分析32例肢体软组织肉瘤切除术中皮肤及肌肉创面缺损行带蒂肌皮瓣修复的临床资料、手术方式和预后。结果术后病理切缘阴性率100豫。术后获得随访26例,随访时间8（2~11）个月,Ⅱ、Ⅲ期肉瘤局部控制率为82豫、76豫,皮瓣修复成活率为95豫。结论规范化的肢体软组织肉瘤手术可降低肿瘤局部复发率,但常致术中皮肤及肌肉创面缺损无法直接缝合,而带蒂肌皮瓣是常用的重要创面缺损修复手段,成功的创面修复可明显提高患者术后的生活质量。     

四肢和躯干浅表软组织肉瘤的手术切除和修复重建

四肢和躯干浅表软组织肉瘤的手术切除和修复重建张如明综述张允祥审校（天津市肿瘤医院骨软科，天津３０００６０）肉瘤是区别于癌的又一大类恶性肿瘤。一般多发生在四肢和躯干浅表的肌肉骨骼系统。近年来，软组织肿瘤已从这一系统中逐渐分离出来，形成或正在形成自己的体...     

岛状肌皮瓣在软组织恶性肿瘤术后修复中的应用

目的 彻底切除软组织的恶性肿瘤。方法 应用胸大肌岛状肌皮瓣,背阔肌皮瓣腹内外皮瓣,臀大肌皮瓣,足外侧皮瓣,切除肿瘤后大面积组织缺损的修复,结果 20例中18例成功,2例失败。其中1例皮瓣坏死,但肌蒂成活。结论 周身各部位的恶性肿瘤大面积切除后组织缺损,该皮瓣修复解决了组织缺损及修复问题。     

侧斜方肌肌皮瓣修复头颈肿瘤术后缺损的初步探索

目的探索侧斜方肌肌皮瓣在头颈肿瘤术后缺损中的作用及其优缺点。方法自2005年6月至2006年6月共采用带蒂侧斜方肌肌皮瓣移植修复头颈肿瘤术后缺损6例,其中舌根癌3例,鼻咽癌放疗后颈淋巴结复发累及皮肤3例,观察肌皮瓣的存活情况、组织移植后功能状态和肿瘤控制的近期疗效。结果全部肌皮瓣存活,无手术并发症,舌根缺损修复后进食、咀嚼、发音均满意,颈部缺损修复后外形满意,无垂肩畸形;全部病例随访6～18个月,1例舌根癌术后6个月死于肿瘤复发,1例鼻咽癌放疗后复发者术后6个月复发,挽救治疗中,其余4例均无瘤生存至今。结论侧斜方肌肌皮瓣可以安全地应用于舌根、颈部缺损修复;手术方便,对供区影响小是该皮瓣的优点;颈横静脉缺如偶有存在,确保充足的静脉回流是手术成功的关键。     

超长下斜方肌肌皮瓣在头部肿瘤术中的应用

应用超长下外方肌肌皮瓣修复头部肿瘤术后缺损３例，效果满意。颈横动脉发出后于肩胛上角外上方１．５ｃｍ处分为深、浅两支，浅降支即为该皮瓣的轴型血管，此点即为皮瓣的旋转轴心。皮的远端可超出斜方肌范围，达肩胛下角下方１７ｃｍ，属任意筋膜皮瓣，皮瓣面积最大达３６ｃｍ×１２ｃｍ，肌肉血管蒂长１６ｃｍ，基本满足颅顶及上颌面部肿瘤切除后修复的需要。皮瓣供区隐蔽，对肩部功能无影响；采用逆行法切取皮瓣，操作简单，不易损伤血管蒂；病人取头低后侧卧位，术中不需要变换体位。     

四肢和躯干软组织肉瘤辅助性近距离治疗进展

软组织肉瘤（soft tissue sarcoma，STS）是来源于问叶组织和周围神经组织的有明显异质性的恶性肿瘤，占成人全身恶性肿瘤的1％，50％～60％发生于肢体，但多数早期无明显症状而被忽视。诊断时肿瘤体积较大，并侵犯周围组织结构，治疗效果不理想，使人们认为软组织肉瘤是放射抗拒的。近年来，随着对软组织肉瘤生物学行为认识的不断提高，人们认识到其细胞对放射线的敏感性，放疗的应用逐渐推广，并占重要地位。     

股前外侧肌皮瓣在舌根缺损修复中的应用

目的 探讨股前外侧肌皮瓣修复舌根缺损的效果。方法 应用股前外侧肌皮瓣修复舌根鳞癌术后缺损一例，术后随访。结果 术后创口一期愈合，一年后随访舌体外形良好，吞咽及语言功能满意。结论 该肌皮瓣动脉血管蒂恒定、皮下脂肪较厚，适于修复舌根软组织缺损；皮瓣血管口径较大．易于吻合；供区隐蔽，取瓣方便。     

胸大肌肌皮瓣在老年头颈部组织缺损修复中的应用

本文报道我科1984年5月～1990年5月收治的老年头颈部恶性肿瘤40例患者(42次手术)。重建下咽颈段食管应用游离空肠4例,前臂游离皮瓣修复腮腺区皮肤缺损2例,胸大肌肌皮瓣重建下咽及部分颈段食管23例,颈段食管2例,舌及口底4例,咽侧壁1例,腮腺区皮肤缺损2例,眼睑及眶内容物切除后修复1例,总的成功率92.5％(37/40),一年生存率86.1％(31/36),三年生存率61.3％(19/31),五年生存率42.8％(9/12)。     

Screening populations at high risk for soft tissue sarcoma and surveillance following soft tissue sarcoma resection

Soft tissue sarcomas (STS) are a rare and diverse group of tumors that affect both adult and pediatric populations. This review discusses current screening recommendations for populations at increased risk for STS, including those with genetic predispositions. We also review surveillance guidelines for those at risk for recurrence following curative-intent surgery.     

Revascularization after segmental resection of lower extremity soft tissue sarcomas

BACKGROUND AND OBJECTIVES: Limb salvage surgery combined with vascular reconstruction has replaced amputation as the preferred treatment of soft tissue sarcomas involving major vascular structures of the extremities. We describe our experience with soft tissue sarcomas involving major vascular structures and examine outcomes according to the type of graft selected for arterial reconstruction. We also examine the effect of venous reconstruction on post-operative edema. METHODS: This retrospective review includes 14 patients with lower extremity soft-tissue sarcomas that encased major vessels, requiring combined limb-preserving tumor resection and revascularization with a synthetic or autogenous saphenous vein graft. Edema in patients with and without venous reconstruction was compared. The incidence of infection, wound dehiscence, and graft thrombosis were compared according to arterial graft type. RESULTS: There was no significant difference in edema in patients with venous reconstruction and those without. There was also no significant difference in infection and graft thrombosis in patients with synthetic grafts and those with autogenous saphenous vein grafts. Wound dehiscence occurred more often in patients with synthetic grafts (P = 0.029). CONCLUSIONS: Although this study was small, these results suggest that further studies are needed to determine the roles that vascular graft selection and venous reconstruction play in clinical outcome.     

Outcome after surgical resection of multiple recurrent retroperitoneal soft tissue sarcoma

IntroductionLocal recurrences (LR) and distant metastases (DM) are common in retroperitoneal soft tissue sarcoma (RPS). Longer time to recurrence and resection of the recurrent lesion have been identified as beneficial prognostic factors for overall survival (OS) upon first tumor relapse. However, prognostic factors concerning OS upon subsequent recurrences are scarcely defined. In this study, we aimed to identify prognostic factors for post-relapse outcome in multiple recurrent RPS.MethodsPatients undergoing resection of primary and recurrent RPS at the University Hospital Heidelberg were retrospectively analyzed. Multivariable Cox regression analyses were performed to identify predictors of overall, LR- and DM-free survival. Subgroup analyses were performed for liposarcoma and leiomyosarcoma patients.Results201 patients with primary disease, 101 patients with first, 66 patients with second and 43 patients with third LR as well as 75 patients with DM were analyzed. More than 12 months to recurrence and resection of recurrence were associated with improved OS after resection of first and second LR (5-year OS for first/second LR; resection: 64%/62%, no resection: 20%/46%). Gross macroscopic incomplete resection of first (p < 0.001), second (p = 0.001), and third recurrences (p < 0.001) was an independent prognostic factor for poor OS.ConclusionDevelopment of LR and DM is frequent in RPS. Once a tumor relapsed, patients benefit from tumor resection not only in case of first, but also in case of subsequent recurrences.     

Surgery of limb and trunk wall soft tissue sarcoma]

For this review of surgery in soft tissue sarcoma, we reviewed literature and added our personal experience. In front of a soft tissue tumour, the major objective is to think it could be a sarcoma. Diagnosis actually is made by core needle biopsies, but sometimes a surgical biopsy is needed. Surgical resection is better defined since ten years and distinguishes resection R0 (in sano), R1 (microscopic residual disease) and R2 (macroscopic residual disease). Quality of resection is determined collegially by confrontation of surgical and pathological reports according recommendations of the French Sarcoma Group (FSG). The risk of local recurrence depends on resection-type and tumour grade. With the help of the surgical classification from FSG, local prognosis is better understood and treatment can be adapted to individual tumours. In experienced hands, local recurrence can be pushed down to near 10 against 20% formerly. Severe complications after sarcoma surgery occur in 14% of cases. Functional outcome studies have benefited from new scoring systems, which complete each other. Isolated limb perfusion is a method that could save limbs in some desperate situations. Conclusion: Due to rarity and treatment specifications, soft tissue sarcoma should be treated in specialised centres.     

Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk.

PURPOSE: To define the rate of local recurrence (LR) and identify prognostic factors for LR for patients with soft tissue sarcoma (STS) treated with function-sparing surgery (FSS) without radiotherapy (RT). PATIENTS AND METHODS: Between 1970 and 1994, 242 patients with STS of the trunk and extremity presented with primary localized disease, 74 of whom were treated with FSS without RT (31%). The median tumor size was 4 cm (range, 0.5 to 31 cm). There were 40 patients with grade 1 tumors and 34 with grade 2 and 3 tumors. Median follow-up was 126 months. RESULTS: The 10-year actuarial local control rate was 93% +/- 4%. Resection margin status was a significant predictor for LR. Patients with closest histologic resection margins of less than 1 cm had a 10-year local control rate of 87% +/- 6% compared with 100% for patients with closest histologic resection margins of >/= 1 cm (P =.04). There was no significant association between LR and tumor grade, size, site (truncal v extremity), or depth (superficial v deep). For all patients, the 10-year actuarial survival rate was 73% +/- 6%. CONCLUSION: The 7% LR rate after treatment of STS with FSS without RT reported herein is comparable to published rates following treatment where adjuvant RT is used. These results suggest there may be a select subset of patients with STS in whom carefully performed FSS may serve as definitive therapy and in whom adjuvant RT may not be necessary. However, further study is needed to carefully define this subset of patients and to identify the optimal surgical approach and technique for patients treated without RT.