The Use of ECMO and Free-Fillet-Leg Flap for Complex Pelvic Reconstruction: A Case Report

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-09-06 DOI:10.1002/micr.31234
Emanuele Cigna, Alberto Bolletta, Mirco Pozzi, Michela Schettino, Olimpia Mani, Lorenzo Andreani, Ugo Boggi, Rodolfo Capanna
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引用次数: 0

Abstract

Advanced sarcoma treatment in complex anatomical regions such as the pelvis poses significant surgical challenges. This report details a case involving a 35-year-old man with recurrent osteosarcoma of the left hemipelvis, who underwent a 16 h surgery for hemipelvectomy and reconstruction using a free tibia and fibula fillet leg flap. The procedure, necessitated by an infected, exposed iliac prosthesis, utilized extracorporeal membrane oxygenation (ECMO) for 8 h to maintain flap viability. The flap, incorporating tibia, fibula, and associated musculature was successfully inset and anastomosed to the left common iliac artery and vein, with additional venous anastomosis to the right iliac vein. Despite postoperative challenges such as venous stasis and intestinal ischemia, necessitating further surgical interventions, the patient achieved mobility with a walker at 3 months post-surgery, with stable conditions observed during a 2 years follow-up. ECMO enabled successful preservation and integration of the free fillet leg flap, demonstrating its potential in complex reconstructive surgeries. Specifically, ECMO may extend free flap viability in complex cases, offering new possibilities for challenging oncological and reconstructive surgeries.

使用 ECMO 和游离腓骨瓣进行复杂骨盆重建:病例报告
在骨盆等复杂解剖区域治疗晚期肉瘤是一项重大的手术挑战。本报告详细介绍了一个病例,患者是一名 35 岁的男性,患有左侧半骨盆复发性骨肉瘤,经过 16 小时的手术进行了半骨盆切除,并使用游离胫骨和腓骨丝状腿瓣进行了重建。由于髂骨假体感染外露,手术需要使用体外膜供氧(ECMO)8小时,以维持皮瓣的活力。结合胫骨、腓骨和相关肌肉组织的皮瓣被成功嵌入并吻合到左侧髂总动脉和静脉,并与右侧髂静脉进行了额外的静脉吻合。尽管术后出现了静脉淤血和肠道缺血等问题,需要进一步进行手术干预,但患者在术后 3 个月就能使用助行器行走,并在两年的随访中观察到病情稳定。ECMO 成功保留并整合了游离菲氏腿瓣,证明了其在复杂重建手术中的潜力。具体来说,ECMO 可以延长复杂病例中游离皮瓣的存活时间,为具有挑战性的肿瘤和整形手术提供了新的可能性。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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