CAJ | 학술논문

目的：分析筋膜皮瓣在四肢关节周围软组织肿瘤切除术后巨大皮肤缺损重建术中的可行性及相关并发症。方法2007年1月至2012年1月，共39例因腕、肘、髋、膝及踝等关节周围软组织恶性肿瘤在我院行病灶广泛切除及邻近部位的筋膜皮瓣转移覆盖创面术。其中男21例，女18例。患者平均年龄45.72(14～73)岁。初诊10例，术后6个月内原发灶再次行扩大切除14例，术后复发15例。研究内容包括：肿瘤切除后皮肤缺损大小、筋膜皮瓣种类、术后伤口及皮瓣愈合情况、患肢外观及功能、肿瘤复发率等。结果切除肿瘤部位包括腕关节5例，肘关节3例，髋关节8例，膝关节6例，踝关节17例。采用的皮瓣包括桡动脉腕上支筋膜皮瓣5例、上臂外侧筋膜皮瓣3例、腹股沟筋膜皮瓣3例、阔筋膜张肌筋膜皮瓣3例、大腿后侧筋膜皮瓣2例、小腿后侧筋膜皮瓣6例及腓肠神经逆行筋膜皮瓣17例。所有筋膜皮瓣均可完整覆盖创面，而且血运良好。除2例发生皮缘少许坏死及1例浅表感染外，其余皮瓣均正常存活。皮瓣外观均可被患者接受，术后患肢关节活动度正常，MSTS 及 TESS 功能评分优良。本组病例未发生大面积的皮瓣坏死及术后皮瓣严重挛缩等并发症。初诊与扩大切除及复发病例在复发率上存在显著性差异。结论筋膜皮瓣具有血供丰富、切取范围大、皮瓣弹性好及厚度适中等优点，术后皮瓣坏死及感染率低，是一类适合在关节周围软组织肿瘤切除后巨大缺损创面应用的临近皮瓣。
목적：분석근막피판재사지관절주위연조직종류절제술후거대피부결손중건술중적가행성급상관병발증。방법2007년1월지2012년1월，공39례인완、주、관、슬급과등관절주위연조직악성종류재아원행병조엄범절제급린근부위적근막피판전이복개창면술。기중남21례，녀18례。환자평균년령45.72(14～73)세。초진10례，술후6개월내원발조재차행확대절제14례，술후복발15례。연구내용포괄：종류절제후피부결손대소、근막피판충류、술후상구급피판유합정황、환지외관급공능、종류복발솔등。결과절제종류부위포괄완관절5례，주관절3례，관관절8례，슬관절6례，과관절17례。채용적피판포괄뇨동맥완상지근막피판5례、상비외측근막피판3례、복고구근막피판3례、활근막장기근막피판3례、대퇴후측근막피판2례、소퇴후측근막피판6례급비장신경역행근막피판17례。소유근막피판균가완정복개창면，이차혈운량호。제2례발생피연소허배사급1례천표감염외，기여피판균정상존활。피판외관균가피환자접수，술후환지관절활동도정상，MSTS 급 TESS 공능평분우량。본조병례미발생대면적적피판배사급술후피판엄중련축등병발증。초진여확대절제급복발병례재복발솔상존재현저성차이。결론근막피판구유혈공봉부、절취범위대、피판탄성호급후도괄중등우점，술후피판배사급감염솔저，시일류괄합재관절주위연조직종류절제후거대결손창면응용적림근피판。
Objective To analyze the feasibility and related complications of fasciocutaneous lfaps in the reconstruction of large skin defects after the resection of soft tissue tumors around the joints of limbs. Methods From January 2007 to January 2012, 39 patients with malignant soft tissue tumors around the wrist, elbow, hip, knee, ankle and so on were treated by wide resection of lesions, and fasciocutaneous lfaps in the adjacent areas were transferred to cover the wound in our hospital. There were 21 males and 18 females, with an average age of 45.72 years old ( range;14-73 years ). Among these patients, 10 cases had primary diagnosis, 14 cases had extended resection again in primary sites within 6 months after the operation and 15 cases had tumor relapse postoperatively. The size of skin defects after tumor resection, types of fasciocutaneous lfaps, postoperative healing of the wound and lfaps, appearance and function of the involved joints, tumor relapse and so on were observed and recorded in all patients. Results 5 patients had tumor resection in the wrist joint, 3 in the elbow joint, 8 in the hip joint, 6 in the knee joint and 17 in the ankle joint. The adapted lfaps included radial wrist upper branch fasciocutaneous lfap in 5 cases, lateral upper arm fasciocutaneous lfap in 3, inguinal fasciocutaneous lfap in 3, broad tensor fasciocutaneous lfap in 3, thigh rear fasciocutaneous lfap in 2, crus rear fasciocutaneous lfap in 6 and sura nervous retrograde fasciocutaneous lfap in 17. All the defects were covered by fasciocutaneous lfaps perfectly, with sufifcient blood supply. All the fasciocutaneous lfaps survived normally, except that 2 patients had light edge necrosis and 1 had superifcial infections. The lfaps were accepted by all patients due to their good appearance. The involved joints had normal range of motion ( ROM ) and excellent musculoskeletal tumor society score ( MSTS ) and Toronto extremity salvage score ( TESS ). No complications such as extensive lfap necrosis, serious contraction of lfaps after the operation and so on were found in the patients. Signiifcant differences existed in the recurring rate among the primary diagnosis, extended resection and relapse groups. Conclusions Fasciocutaneous lfaps have the advantages such as sufifcient blood supply, large area of coverage, good elastic, moderate thickness, low necrosis and infection rate of lfaps postoperatively and so on, which are suitable for repairing large defects after the resection of soft tissue tumors around the joints.