[Clinical efficacy of thinned free flaps in reconstructing the wounds following excision of malignant extremity tumors].

Abstract

Objective: To evaluate the clinical efficacy of thinned free flaps in reconstructing the wounds following excision of malignant extremity tumors. Methods: This study was a retrospective case series study. From June 2023 to February 2026, 17 patients (11 males and 6 females, aged 38-91 years) with malignant extremity tumors who met the inclusion criteria were admitted to the Department of Hand Surgery of Beijing Jishuitan Hospital of Capital Medical University. Tumors were located in the upper extremity in 9 patients and in the lower extremity in 8 patients, including 6 patients of squamous cell carcinoma, 2 patients of dermato-fibrosarcoma protuberans, 2 patients of liposarcoma, 2 patients of synovial sarcoma, 2 patients of malignant peripheral nerve sheath tumor, 1 patient of epithelioid sarcoma, 1 patient of angiosarcoma, and 1 patient of cutaneous carcinoma. Wide excision of the tumor was performed, with soft tissue defect areas ranging from 4 cm×4 cm to 24 cm×12 cm. Thinned free flaps were used for wound reconstruction, including 7 anterolateral thigh flaps, 6 groin flaps, 2 medial sural artery perforator flaps, 1 inferior epigastric artery perforator flap, and 1 medial plantar flap. Flaps were harvested with areas ranging from 4 cm×4 cm to 24 cm×13 cm, with a thickness of 4-10 mm (with a mean of 5.8 mm). Donor site wounds were closed by direct suture, local relay flaps or skin grafting. Postoperative flap survival was recorded, as well as the occurrence of complications at the flap recipient site including infection, hematoma, and delayed wound healing, and the healing status and complications at the donor site. A comprehensive assessment of flap reconstructive outcomes was conducted at the final follow-up. Tumor prognosis of all patients was tracked and documented. Results: Postoperatively, the flaps in 16 patients survived uneventfully. One patient who underwent groin flap reconstruction for wound following resection of angiosarcoma on the dorsum of the hand developed epidermal necrosis at the distal portion of the flap on postoperative day 3, which healed after dressing changes. No infection, hematoma, or delayed wound healing occurred in any flap recipient site. Donor site wounds healed uneventfully in 15 patients but showed delayed healing in 2 patients. No major complications were observed in any donor site wound. At the last follow-up, the flap reconstructive outcomes were rated as excellent in 14 patients and good in 3 patients. The follow-up period ranged from 2 to 34 months. Local recurrence of tumors occurred in 3 patients. Metastasis of tumors developed in 2 patients. The remaining 12 patients showed no signs of local tumor recurrence or distant metastasis. Conclusions: Clinical use of thinned free flaps to reconstruct the wounds following excision of malignant extremity tumors yields excellent reconstructive outcomes, with few donor site complications.