Effects of Neoadjuvant Radiation and Recipient Vessel Characteristics on Microvascular Complication Rates in Reconstruction of Lower Extremity Soft Tissue Sarcoma Defects.

IF 2.2 3区 医学 Q2 SURGERY
Rebecca L Farmer, Justin Easton, Ruston Sanchez, Elisa Emanuelli, Eldon Mah
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引用次数: 0

Abstract

Background:  The treatment approach for soft tissue sarcomas (STS) of the lower extremity has shifted toward the use of neoadjuvant radiation combined with limb-sparing surgery (LSS). The resulting defects often require reconstruction with free tissue transfer for adequate outcomes. Data have demonstrated a potentially increased risk of microvascular complications for free flaps performed using irradiated recipient vessels. Similarly, certain anatomic areas of the lower extremity have a high proportion of unnamed perforators that are available as recipient vessels, increasing the technical difficulty. We aimed to determine if the characteristics of recipient vessels that were used for the reconstruction of STS defects influenced rates of microvascular complications in our patients.

Methods:  A retrospective chart review of all patients who underwent reconstruction of lower extremity STS defects with free tissue transfer from 2009 to 2020 was conducted. Data regarding recipient vessel type (axial vessel vs. unnamed perforator), radiation status of the recipient vessels (irradiated vs. non-irradiated), and microvascular complications were compared across groups.

Results:  A total of 204 free flaps were included. The overall microvascular complication rate was 13.7% (28 cases). Most microvascular complications were detected postoperatively (82.1%) rather than intraoperatively, with the majority involving venous congestion/thrombosis (20 cases, 71.4%). While there was a trend toward increased microvascular complications with the use of irradiated recipient vessels (27 cases, 96.4%), this did not reach statistical significance (OR = 1.98, p = 0.52). The use of perforating branches as recipient vessels did not confer an increased risk of microvascular complications (OR = 0.87, p = 0.75).

Conclusion:  The reconstruction of irradiated lower-extremity STS defects represents a particularly challenging issue. This analysis demonstrates that free tissue transfer can be safely performed using irradiated vessels without a significantly increased risk of microvascular complications. Furthermore, unnamed perforating branches can be successfully used for reconstruction in anatomically challenging areas of the lower extremity.

新辅助放射和受体血管特征对下肢软组织肉瘤缺损重建中微血管并发症发生率的影响
背景:下肢软组织肉瘤(STS)的治疗方法已转向使用新辅助放疗结合保肢手术(LSS)。由此造成的缺损往往需要通过游离组织移植进行重建,以获得足够的疗效。有数据显示,使用受体血管照射的游离皮瓣可能会增加微血管并发症的风险。同样,下肢的某些解剖区域有较高比例的未命名穿孔器可用作受体血管,从而增加了技术难度。我们旨在确定用于重建STS缺损的受体血管的特征是否会影响患者微血管并发症的发生率:我们对 2009-2020 年间所有接受游离组织移植重建下肢 STS 缺损的患者进行了回顾性病历审查。比较了各组患者的受体血管类型(轴向血管与无名穿孔血管)、受体血管的放射状态(放射与非放射)以及微血管并发症等数据:结果:共纳入 204 个游离皮瓣。结果:共纳入 204 个游离皮瓣,微血管并发症总发生率为 13.7%(28 例)。大多数微血管并发症是在术后(82.1%)而非术中发现的,其中大部分涉及静脉充血/血栓形成(20 例,71.4%)。虽然使用照射过的受体血管会增加微血管并发症的发生率(27 例,96.4%),但未达到统计学意义(OR = 1.98,P = 0.52)。使用穿孔分支作为受体血管不会增加微血管并发症的风险(OR = 0.87,P = 0.75):结论:重建放射性下肢STS缺损是一个特别具有挑战性的问题。这项分析表明,使用放射性血管可以安全地进行游离组织转移,而不会显著增加微血管并发症的风险。此外,无名穿孔分支也可成功用于下肢解剖上具有挑战性区域的重建。
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来源期刊
CiteScore
4.50
自引率
28.60%
发文量
80
审稿时长
1 months
期刊介绍: The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers. The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases. The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.
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