带血管蒂肌瓣转移用于胫腓骨骨肉瘤保肢术

目的 报告四肢恶性肿瘤广泛切除保肢手术，应用带血管蒂肌瓣修复和重建软组织成功的经验。方法 广泛切除小腿骨肉瘤及瘤周软组织，得用人工假体或吻合血管游离腓骨和移植等方法重建骨骼，局部转移带血管蒂的腓骨肌或比目鱼肌肌瓣，欠组织缺损。结果 临床应用７例，带血管蒂的肌瓣成活良好，无切口并发症，膝关节活动度提高，假体表面皮肤移动性良好。结论 带血管蒂的肌瓣在胫腓骨恶性肿瘤的保肢术中，对于重建软组织缺损和保证切

Vascularized muscular flap transfers in the shank salvage of bone tumor on tibia or fibula

Objective To evaluate the muscular flap transfer for the shank salvage in patients with osteosarcoma. Method Seven patients with osteosarcoma of the tibia or fibula were treated, aged from 12 to 24 years. Shank salvage involves three phases, (l )wide resection of the tumor, (2)reconstruction of the bone and joint defect by artificial prosthesis or vascularised fibular autograft combined with allograft, and (3)reconstruction of the soft tissue by muscular transfer. Result To reconstruct the soft tissues, 5 patients underwent medial head of gastrocnemius flap in the proximal tibia, 1 the lateral in the proximal fibula and 1 soleus flap in the distal fibula. The follow-up period after limb salvage was 2-32 months. In spite of preoperative chemotherapy and postoperative brachytherapy,all with muscular flap got wound healing by first intention with excellent soft-tissue cover,without any complications. Conclusion The muscular transfer is an effective way to reconstruct soft tissue and cover prosthesis. It allows for better wound healing rather than primary wound closure alone,especially combined with adjuvant therapy' Muscular transfer should be performed routinely in the shank salvage surgery in order to avoid complications of wound