SOFT TISSUE RECONSTRUCTION AFTER RESECTION OF MUSCULOSKELETAL TUMORS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JI Tao ¹ , WANG Tianbing ² , GUO Wei ¹

1Musculoskeletal Tumor Center, 2Department of Trauma Orthopaedics, People’s Hospital, Peking University, Beijing, 100044, P.R.China. Corresponding author: GUO Wei, E-mail: bonetumor@163.com;

Corresponding author：

Keywords：

Musculoskeletal tumor; Soft tissue reconstruction; Limb salvage; Flap

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Objective To evaluate the effectiveness of soft tissue reconstruction after resection of musculoskeletal tumor and to discuss the strategy of soft tissue reconstruction. Methods Between June 2003 and December 2010, 90 patients with musculoskeletal tumor underwent tumor resection and soft tissue reconstruction. There were 59 males and 31 females with a median age of 37.2 years (range, 9-85 years), including 52 bone tumors and 38 soft tissue tumors. One stage reconstruction of soft tissue was performed after tumor resection in 75 cases; reconstruction of soft tissue was performed after debridement in 7 cases of wound dehiscence; and two stage reconstruction of soft tissue was performed after debridement and vacuum sealing drainage placement in 8 cases of infected wounds. The gastrocnemiums flap was used in 40 cases, the latissimus dorsi myocutaneous flap in 6 cases, rectus abdominis myocutaneous flap in 4 cases, gluteus maximus musculocutaneous flap in 1 case, pectoralis major muscle flap in 1 case, cross-abdominal flap in 1 case, local transfer flap in 27 cases, pedicled flaps in 5 cases, and skin grafts in 5 cases. The size of the flap ranged from 6.5 cm × 4.5 cm to 21.0 cm × 9.0 cm. Results Eighty-seven flaps survived, and incisions healed by first intention in 81 cases. In 6 cases of healing by second intention, 2 had partial flap necrosis, which was cured by dressing change; 3 had delayed healing; 1 had mild infection, which was cured after conservative treatment. Wound of donor site healed primarily, and the grafted skin survived. Seventy-three patients were followed up 10-102 months (mean, 36.1 months). Local tumor recurrence was observed in 6 patients, who received second resection at 2-27 months (mean, 8.2 months) after operation. Thirteen patients dead of primary disease at 6-34 months (mean, 19.2 months) after operation. Conclusion The defects caused by resection of musculoskeletal tumor require soft tissue reconstructions. Optimal reconstruction can enhance wound closure, decrease incidence of wound complication, preserve limb function.

Citation： JI Tao,WANG Tianbing,GUO Wei. SOFT TISSUE RECONSTRUCTION AFTER RESECTION OF MUSCULOSKELETAL TUMORS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(8): 950-954. doi: Copy

1.	Buchner M, Zeifang F, Bernd L. Medial gastrocnemius muscle flap in limb-sparing surgery of malignant bone tumors of the proximal tibia: mid-term results in 25 patients. Ann Plast Surg, 2003, 51(3): 266-272.
2.	Kramers-de Quervain IA, Läuffer JM, Käch K, et al. Functional donor-site morbidity during level and uphill gait after a gastrocnemius or soleus muscle-flap procedure. J Bone Joint Surg (Am), 2001, 83-A(2): 239-246.
3.	Davidge KM, Wunder J, Tomlinson G, et al. Function and health status outcomes following soft tissue reconstruction for limb preservation in extremity soft tissue sarcoma. Ann Surg Oncol, 2010, 17(4): 1052-1062.
4.	Moreira-Gonzalez A, Djohan R, Lohman R. Considerations surrounding reconstruction after resection of musculoskeletal sarcomas. Cleve Clin J Med, 2010, 77 Suppl 1: S18-22.
5.	Misra A, Mistry N, Grimer R, et al. The management of soft tissue sarcoma. J Plast Reconstr Aesthet Surg, 2009, 62(2): 161-174.
6.	Morii T, Mochizuki K, Takushima A, et al. Soft tissue reconstruction using vascularized tissue transplantation following resection of musculoskeletal sarcoma: evaluation of oncologic and functional outcomes in 55 cases. Ann Plast Surg, 2009, 62(3): 252-257.
7.	Heller L, Kronowitz SJ. Lower extremity reconstruction. J Surg Oncol, 2006, 94(6): 479-489.
8.	Heller L, Ballo MT, Cormier JN, et al. Staged reconstruction for resection wounds in sarcoma patients treated with brachytherapy. Ann Plast Surg, 2008, 60(1): 58-63.
9.	Evans GR, Black JJ, Robb GL, et al. Adjuvant therapy: the effects on microvascular lower extremity reconstruction. Ann Plast Surg, 1997, 39(2): 141-144.
10.	Peat BG, Bell RS, Davis A, et al. Wound-healing complications after soft-tissue sarcoma surgery. Plast Reconstr Surg, 1994, 93(5): 980-987.
11.	Barwick WJ, Goldberg JA, Scully SP, et al. Vascularized tissue transfer for closure of irradiated wounds after soft tissue sarcoma resection. Ann Surg, 1992, 216(5): 591-595.
12.	Kunisada T, Ngan SY, Powell G, et al. Wound complications following pre-operative radiotherapy for soft tissue sarcoma. Eur J Surg Oncol, 2002, 28(1): 75-79.
13.	Hamdi M, Spano A, Van Landuyt K, et al. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg, 2008, 121(2): 389-396.
14.	Chim H, Tan BK, Tan MH, et al. Optimizing the use of local muscle flaps for knee megaprosthesis coverage. Ann Plast Surg, 2007, 59(4): 398-403.
15.	Mastorakos DP, Disa JJ, Athanasian E, et al. Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction. Plast Reconstr Surg, 2002, 109(5): 1567-1573.
16.	Ver Halen JP, Yu P, Skoracki RJ, et al. Reconstruction of massive oncologic defects using free fillet flaps. Plast Reconstr Surg, 2010, 125(3): 913-922.
17.	Springfield D. Surgery for MSK tumors: 1971-2011. Skeletal Radiol, 2011, 40(9): 1233-1237.
18.	Yoshida S, Yokoyama R, Sakamoto A. Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap. Microsurgery, 2011, 31(8): 655-658.

1. Buchner M, Zeifang F, Bernd L. Medial gastrocnemius muscle flap in limb-sparing surgery of malignant bone tumors of the proximal tibia: mid-term results in 25 patients. Ann Plast Surg, 2003, 51(3): 266-272.
2. Kramers-de Quervain IA, Läuffer JM, Käch K, et al. Functional donor-site morbidity during level and uphill gait after a gastrocnemius or soleus muscle-flap procedure. J Bone Joint Surg (Am), 2001, 83-A(2): 239-246.
3. Davidge KM, Wunder J, Tomlinson G, et al. Function and health status outcomes following soft tissue reconstruction for limb preservation in extremity soft tissue sarcoma. Ann Surg Oncol, 2010, 17(4): 1052-1062.
4. Moreira-Gonzalez A, Djohan R, Lohman R. Considerations surrounding reconstruction after resection of musculoskeletal sarcomas. Cleve Clin J Med, 2010, 77 Suppl 1: S18-22.
5. Misra A, Mistry N, Grimer R, et al. The management of soft tissue sarcoma. J Plast Reconstr Aesthet Surg, 2009, 62(2): 161-174.
6. Morii T, Mochizuki K, Takushima A, et al. Soft tissue reconstruction using vascularized tissue transplantation following resection of musculoskeletal sarcoma: evaluation of oncologic and functional outcomes in 55 cases. Ann Plast Surg, 2009, 62(3): 252-257.
7. Heller L, Kronowitz SJ. Lower extremity reconstruction. J Surg Oncol, 2006, 94(6): 479-489.
8. Heller L, Ballo MT, Cormier JN, et al. Staged reconstruction for resection wounds in sarcoma patients treated with brachytherapy. Ann Plast Surg, 2008, 60(1): 58-63.
9. Evans GR, Black JJ, Robb GL, et al. Adjuvant therapy: the effects on microvascular lower extremity reconstruction. Ann Plast Surg, 1997, 39(2): 141-144.
10. Peat BG, Bell RS, Davis A, et al. Wound-healing complications after soft-tissue sarcoma surgery. Plast Reconstr Surg, 1994, 93(5): 980-987.
11. Barwick WJ, Goldberg JA, Scully SP, et al. Vascularized tissue transfer for closure of irradiated wounds after soft tissue sarcoma resection. Ann Surg, 1992, 216(5): 591-595.
12. Kunisada T, Ngan SY, Powell G, et al. Wound complications following pre-operative radiotherapy for soft tissue sarcoma. Eur J Surg Oncol, 2002, 28(1): 75-79.
13. Hamdi M, Spano A, Van Landuyt K, et al. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg, 2008, 121(2): 389-396.
14. Chim H, Tan BK, Tan MH, et al. Optimizing the use of local muscle flaps for knee megaprosthesis coverage. Ann Plast Surg, 2007, 59(4): 398-403.
15. Mastorakos DP, Disa JJ, Athanasian E, et al. Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction. Plast Reconstr Surg, 2002, 109(5): 1567-1573.
16. Ver Halen JP, Yu P, Skoracki RJ, et al. Reconstruction of massive oncologic defects using free fillet flaps. Plast Reconstr Surg, 2010, 125(3): 913-922.
17. Springfield D. Surgery for MSK tumors: 1971-2011. Skeletal Radiol, 2011, 40(9): 1233-1237.
18. Yoshida S, Yokoyama R, Sakamoto A. Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap. Microsurgery, 2011, 31(8): 655-658.

Chinese Journal of Reparative and Reconstructive Surgery

SOFT TISSUE RECONSTRUCTION AFTER RESECTION OF MUSCULOSKELETAL TUMORS

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