内侧腓肠肌肌(皮)瓣在小腿近端恶性肿瘤手术中的应用

目的探讨采用内侧腓肠肌肌(皮)瓣修复小腿近端恶性肿瘤切除后缺损的方法及临床疗效。方法自2015年10月至2019年1月,对6例小腿近端恶性肿瘤切除后的胫前软组织缺损患者分别采用内侧腓肠肌肌(皮)瓣转移修复、内侧腓肠肌肌瓣转移联合人工网状补片重建伸膝功能,并于术后3个月对切口的愈合情况、肢体功能以及肿瘤控制情况进行评价。结果本组共6例患者,术后获随访11~34个月,平均(13.3±3.2)个月。5例切口一期愈合(占83.3%);1例皮瓣边缘发生部分坏死,经换药后愈合。1例于术后12个月因肿瘤肺转移而死亡;1例于术后3个月时肿瘤局部复发接受了二次手术治疗;其余4例肿瘤无复发,效果较满意。患者术后3个月MSTS评分为17~29分,平均(26.2±4.8)分;评定下肢功能的优良率为83.3%(5/6)。结论采用内侧腓肠肌肌(皮)瓣转移修复小腿近端恶性肿瘤切除后的软组织缺损,以及联合人工网状补片行伸膝功能重建,其方法简单易行,可获得较满意的临床效果。

Application of medial gastrocnemius muscle flap in the operation of malignant tumor of proximal leg

Objective To explore the clinical efficacy of medial gastrocnemius muscle flap in the repair of proximal leg defect after malignant tumor resection. Methods From October 2015 to January 2019, 6 patients with malignant tumor of proximal leg underwent the operation. The medial gastrocnemius muscle flap was used to repair anterior tibial soft tissue defect after malignant tumor resection. The medial gastrocnemius muscle flap combined with artificial mesh patch was used to reconstruct the function of knee extension. The condition of incision healing, limb function and local recurrence was evaluated at 3 months after operation. Results All patients were followed up from 11 to 34 months, with an average of(13.3±3.2) months. The incisions were healing by first intention in 5 patients(83.3%). Partial necrosis at the edge of flap occurred in 1 patient and healed after dressing change. During the follow-up period, 1 patient died of pulmonary metastasis of tumor at 12 months after operation and 1 patient received secondary operation for local recurrence of tumor at 3 months after operation. The remaining 4 patients had no recurrence of tumor and were satisfied with the efficacy. The Musculoskeletal Tumor Society(MSTS) scores of patients ranged from 17 to 29 at 3 months after operation, with an average of(26.2±4.8). The excellent and good rate of lower limbs function was 83.3%(5/6). Conclusion The application of medial gastrocnemius muscle flap in the repair of soft tissue defect of proximal leg after malignant tumor resection and combined with artificial mesh patch in the reconstruction of function of knee extension was able to obtain satisfactory clinical efficacy. This method was simple and convenient to perform.