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Tytuł:
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Optimization of Free-Flap Limb Salvage and Maximizing Function and Quality of Life Following Oncologic Resection: 12-Year Experience.
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Autorzy:
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Chang EI; Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA. .
Nguyen AT; Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
Hughes JK; Department of Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA.
Moeller J; Department of Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA.
Zhang H; Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
Crosby MA; Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
Skoracki RJ; Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
Chang DW; Section of Plastic Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA.
Lewis VO; Department of Orthopedic Surgery, MD Anderson Cancer Center, Houston, TX, USA.
Hanasono MM; Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
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Źródło:
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Annals of surgical oncology [Ann Surg Oncol] 2016 Mar; Vol. 23 (3), pp. 1036-43. Date of Electronic Publication: 2015 Oct 14.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 2005- : New York, NY : Springer
Original Publication: New York, NY : Raven Press, c1994-
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MeSH Terms:
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Quality of Life*
Free Tissue Flaps/*standards
Limb Salvage/*standards
Neoplasms/*surgery
Plastic Surgery Procedures/*standards
Activities of Daily Living ; Amputation, Surgical ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prognosis ; Retrospective Studies
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Entry Date(s):
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Date Created: 20151016 Date Completed: 20161110 Latest Revision: 20221207
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Update Code:
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20240104
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DOI:
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10.1245/s10434-015-4905-5
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PMID:
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26467452
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Introduction: A knowledge gap exists regarding factors to optimize limb salvage and function following oncologic resection.
Methods: We conducted a retrospective review of all free flaps performed for upper extremity (UE) and lower extremity (LE) salvage from 2000 to 2012.
Results: Overall, 220 patients underwent free-flap reconstruction for limb salvage (UE: 64, and LE: 156). Flaps were classified as muscle-only (n = 77), myocutaneous (MC; n = 67), or fasciocutaneous (FC; n = 76). Smoking, diabetes, peripheral vascular disease, and prior chemotherapy or radiation had no impact on complications, while osteomyelitis significantly increased the risk of infection (odds ratio [OR] 19.5, confidence interval [95% CI] 3.77-100.64; p = 0.0004), wound healing complications (OR 7.51, 95% CI 2.21-25.49; p = 0.001), and amputation (OR 4.63, 95% CI 1.41-15.19; p = 0.01). Hardware increased the risk for flap loss (OR 4.92, 95% CI 1.33-18.23; p = 0.017). MC and FC flaps had increased risks for hematoma (p = 0.02) and reoperation for microvascular complications (p = 0.005) but were at lower risk for infection (OR 0.14, 95% CI 0.02-0.87; p = 0.03) compared with muscle-only flaps. There were a total of seven total flap losses (3.2%), with significantly increased risks for MC/FC flaps (OR 2.58, 95% CI 1.06-6.26; p = 0.03). For LE, 103 patients (66.3%) were fully ambulatory, while 23 (14.7%) were ambulatory with assistance (mean Musculoskeletal Tumor Society score (MSTS) 80.2, and Karnofsky score 84.0). For UE, 49 patients (76.6%) were able to perform their activities of daily living independently (mean MSTS 80.2, and Karnofsky score 86.0). Overall, 190 patients (86.4%) were successfully salvaged.
Conclusions: Free flaps can be performed reliably for limb salvage following tumor extirpation. While MC/FC flaps demonstrated improved postoperative function, they were at significantly higher risk for take-backs and total flap loss.
