四肢骨骼、肌肉系统肿瘤切除后软组织缺损的修复

目的探讨四肢骨骼、肌肉系统肿瘤切除后软组织缺损的修复。方法对1992年～2004年收治的骨肿瘤23例(以局部活检、局部复发污染较重及局部曾行放疗软组织条件较差为主)行肿瘤切除，所遗软组织缺损：病变位于小腿上段者行腓肠肌内侧头肌瓣转移并游离植皮18例，5例病灶位于小腿下段者予吻合血管的皮瓣或肌皮瓣修复。软组织肿瘤切除后皮肤缺损15例，均行游离皮瓣或肌皮瓣修复。结果转移肌瓣并游离植皮及吻合血管的皮瓣或肌皮瓣全部成活。结论胫骨上段肿瘤彻底切除后所遗软组织缺损，以转移腓肠肌内侧头肌瓣并以中厚皮片游离植皮修复，方法简单、可靠；其它部位骨骼、肌肉系统肿瘤彻底切除后所遗软组织缺损，以吻合血管的腹直肌或胸脐皮瓣修复较理想，但要求有好的显微外科技术。

Recovery of soft-tissue defects in extremities after resection of musculoskeletal tumor

Objective To discuss the repair of soft-tissue defects in extremities after resection of musculoskeletal tumor. Methods Eighteen cases with lesion in the upper tibia were treated by local transfer of the medial caput gastrocnemius and skin graft while 5 cases with lesion in the lower tibia were reconstructed by the rectus abdominis free flap, 15 cases with soft-tissue defects after resection of soft-tissue tumor were repaired by the rectus abdominis free flap or thoracoumbilical free flap. The patients with the poor soft tissue, needing wide resection because of unreasonable local biopsy, local recurrence pollution and local radiotherapy, were chosen from 1992 to 2004. Results All the local transfer of gastrocnemius and free flap were survived.Conclusion The way to repair the soft-tissue defects in the upper tibia after tumor resection by the medial caput gastrocnemius and skin graft is simple and reliable. The soft-tissue defects after resection of musculoskeletal tumor in other sites recovered by free flap such as rectus abdominis or thoracoumbilical flap is ideal, but requiring good microsurgical technique.