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。

Gastrocnemius muscle flap for repair the defects of soft tissue sarcoma at the knee

Objective To investigate the clinical efficacy of the application of the gastrocnemius muscle flap for repairing soft tissue defects around knee joint after wide excision of soft tissue sarcoma. Methods The retrospective analysis of complete follow-up data of soft tissue sarcoma around knee joint treated from March 2009 to May 2012,in 12 cases, 5 males and 7 females, age 43-82 years old, an average of 58 years of age. There were 6 cases of initial issuance and 6 cases of recurrence. The pathological diagnosis of the 5 cases were malignant fibrous histioeytoma, 2 cases were synovial sarcoma, 2 cases were liposarcoma, 1 case was fibrosareo- ma, 1 case was clear cell sarcoma and 1 case was epithelioid sarcoma. All patients underwent wide excision sur- gery, soft tissue defects area was： maximum of 10 cm x 13 cm, minimum 6 cm x 8 em. Based on the differ- ent parts of the defects ,we repaired soft tissue sarcomas with wide excision of soft tissue defects with gastrocne- mius muscle flap. Results The group of 12 cases of the gastrocnemius muscle flaps survived successfully. Pa- tients were followed up for 3-39 months, an average of 15 months, the whole group of patients without recur- rence, 1 case of synovial sarcoma was lung metastases after 8 months, survived. The texture of the transplanted muscle flap, skin color and by the district, including 4 cases of pediele look slightly bloated, and the rest of theappearance and function were good, knee flexion and extension were no limited. Conclusions The vascular of gastrocnemius muscle flap is constant, operation is simple and intraoperative muscle flap survival rate is good. It is a good choice to repair defects of soft tissue sarcoma around the knee joint after wide excision by gastrocnemi- us muscle flap.