Ramy Samargandi , Rayane Benhenneda , Philippe Rosset , Audrey Bisson-Patoue , Louis-Romée Le Nail
{"title":"埋入式去上皮化皮瓣:填补大腿肉瘤切除后死区的原始解决方案。12例手术方法及疗效分析。","authors":"Ramy Samargandi , Rayane Benhenneda , Philippe Rosset , Audrey Bisson-Patoue , Louis-Romée Le Nail","doi":"10.1016/j.otsr.2023.103748","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span>Soft tissue sarcomas (STS) are often treated with </span>wide excision<span><span> in combination with adjuvant or neoadjuvant radiotherapy. This is currently the gold standard procedure for the treatment of STS that arise in the extremities. Wound healing complications frequently occur and negatively affect the prognosis. One of the options is to use a buried de-epithelialized flap as it can increase the </span>lymphatic flow, fill the dead space, and cover neurovascular structures and implants. This aim of this retrospective study were two-fold. 1) Describe the surgical technique for this buried de-epithelialized flap after STS removal in the thigh. 2)Evaluate the efficacy of the buried de-epithelialized flap for decreasing wound complications based on a small case series and compare it with previous publications.</span></p></div><div><h3>Hypothesis</h3><p>We hypothesized that the complication rate of this flap is not higher than the published complication rate for traditional flaps.</p></div><div><h3>Materials and methods</h3><p>Twelve patients (7 women and 5 men) with a mean age of 62<!--> <!-->±<!--> <!-->12<!--> <!-->years (38–76), who underwent surgical removal of an STS in the thigh with coverage by a buried de-epithelialized flap were reviewed at a mean follow-up of 15.8<!--> <!-->months (range 8–24).</p></div><div><h3>Results</h3><p>Two patients presented with a postoperative wound infection<span><span><span><span> (17%): one superficial and one deep at the surgical site. Neither required an additional plastic surgery procedure<span>. Another patient had a dislocation of their total hip arthroplasty that was managed by </span></span>closed reduction. One patient died from metastatic progression. There was no </span>skin necrosis of the superficial skin edges, no hematoma or </span>seroma in the other 10 patients. The flap was still visible on cross-sectional imaging at 1 month postoperative with no fluid between the tissue planes or signs of necrosis. The rate of wound healing complications that required surgical treatment was 17% in our case series, versus 16 to 56% in previous publications reporting the results of suture closure only.</span></p></div><div><h3>Conclusion</h3><p>A buried de-epithelialized flap reduces the risk of skin complications by filling dead space, improving lymphatic flow and covering critical structures. It is a reliable and reproducible option after wide local excision of STS in the thigh, with no additional morbidity.</p></div><div><h3>Level of evidence</h3><p>IV, retrospective study.</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Buried de-epithelialized flap: An original solution to fill dead space after sarcoma resection in the thigh. Surgical technique and results of 12 cases\",\"authors\":\"Ramy Samargandi , Rayane Benhenneda , Philippe Rosset , Audrey Bisson-Patoue , Louis-Romée Le Nail\",\"doi\":\"10.1016/j.otsr.2023.103748\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p><span>Soft tissue sarcomas (STS) are often treated with </span>wide excision<span><span> in combination with adjuvant or neoadjuvant radiotherapy. This is currently the gold standard procedure for the treatment of STS that arise in the extremities. Wound healing complications frequently occur and negatively affect the prognosis. One of the options is to use a buried de-epithelialized flap as it can increase the </span>lymphatic flow, fill the dead space, and cover neurovascular structures and implants. This aim of this retrospective study were two-fold. 1) Describe the surgical technique for this buried de-epithelialized flap after STS removal in the thigh. 2)Evaluate the efficacy of the buried de-epithelialized flap for decreasing wound complications based on a small case series and compare it with previous publications.</span></p></div><div><h3>Hypothesis</h3><p>We hypothesized that the complication rate of this flap is not higher than the published complication rate for traditional flaps.</p></div><div><h3>Materials and methods</h3><p>Twelve patients (7 women and 5 men) with a mean age of 62<!--> <!-->±<!--> <!-->12<!--> <!-->years (38–76), who underwent surgical removal of an STS in the thigh with coverage by a buried de-epithelialized flap were reviewed at a mean follow-up of 15.8<!--> <!-->months (range 8–24).</p></div><div><h3>Results</h3><p>Two patients presented with a postoperative wound infection<span><span><span><span> (17%): one superficial and one deep at the surgical site. Neither required an additional plastic surgery procedure<span>. Another patient had a dislocation of their total hip arthroplasty that was managed by </span></span>closed reduction. One patient died from metastatic progression. There was no </span>skin necrosis of the superficial skin edges, no hematoma or </span>seroma in the other 10 patients. The flap was still visible on cross-sectional imaging at 1 month postoperative with no fluid between the tissue planes or signs of necrosis. The rate of wound healing complications that required surgical treatment was 17% in our case series, versus 16 to 56% in previous publications reporting the results of suture closure only.</span></p></div><div><h3>Conclusion</h3><p>A buried de-epithelialized flap reduces the risk of skin complications by filling dead space, improving lymphatic flow and covering critical structures. It is a reliable and reproducible option after wide local excision of STS in the thigh, with no additional morbidity.</p></div><div><h3>Level of evidence</h3><p>IV, retrospective study.</p></div>\",\"PeriodicalId\":54664,\"journal\":{\"name\":\"Orthopaedics & Traumatology-Surgery & Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Orthopaedics & Traumatology-Surgery & Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1877056823002906\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedics & Traumatology-Surgery & Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1877056823002906","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Buried de-epithelialized flap: An original solution to fill dead space after sarcoma resection in the thigh. Surgical technique and results of 12 cases
Introduction
Soft tissue sarcomas (STS) are often treated with wide excision in combination with adjuvant or neoadjuvant radiotherapy. This is currently the gold standard procedure for the treatment of STS that arise in the extremities. Wound healing complications frequently occur and negatively affect the prognosis. One of the options is to use a buried de-epithelialized flap as it can increase the lymphatic flow, fill the dead space, and cover neurovascular structures and implants. This aim of this retrospective study were two-fold. 1) Describe the surgical technique for this buried de-epithelialized flap after STS removal in the thigh. 2)Evaluate the efficacy of the buried de-epithelialized flap for decreasing wound complications based on a small case series and compare it with previous publications.
Hypothesis
We hypothesized that the complication rate of this flap is not higher than the published complication rate for traditional flaps.
Materials and methods
Twelve patients (7 women and 5 men) with a mean age of 62 ± 12 years (38–76), who underwent surgical removal of an STS in the thigh with coverage by a buried de-epithelialized flap were reviewed at a mean follow-up of 15.8 months (range 8–24).
Results
Two patients presented with a postoperative wound infection (17%): one superficial and one deep at the surgical site. Neither required an additional plastic surgery procedure. Another patient had a dislocation of their total hip arthroplasty that was managed by closed reduction. One patient died from metastatic progression. There was no skin necrosis of the superficial skin edges, no hematoma or seroma in the other 10 patients. The flap was still visible on cross-sectional imaging at 1 month postoperative with no fluid between the tissue planes or signs of necrosis. The rate of wound healing complications that required surgical treatment was 17% in our case series, versus 16 to 56% in previous publications reporting the results of suture closure only.
Conclusion
A buried de-epithelialized flap reduces the risk of skin complications by filling dead space, improving lymphatic flow and covering critical structures. It is a reliable and reproducible option after wide local excision of STS in the thigh, with no additional morbidity.
期刊介绍:
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.