Free Vascularized Fibula Salvage of Failed CPH in Pediatric Sarcoma Patients

Q2 Medicine

Sarcoma Pub Date : 2022-05-09 DOI:10.1155/2022/6240293

Giovanna R. Pires, Whitney D. Moss, Jessica Luo, Ruyan Zhang, Kevin B. Jones, A. Kwok, J. Agarwal

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引用次数: 0

Abstract

Background Due to extended life expectancy and recent improvements in surgical techniques, limb salvage has replaced amputation as the gold standard and is now performed in 90–95% of upper extremity malignancies. However, many of these salvage procedures are associated with significant postsurgical complications. In particular, the clavicula pro humero (CPH) procedure is associated with high rates of nonunion. We present our experience with upper extremity salvage using the free vascularized fibular flap (VFF) after failure or nonunion of the original CPH procedure in the pediatric population. Methods Five patients under the age of 18 diagnosed with upper extremity sarcoma who underwent tumor resection with immediate CPH reconstruction complicated with nonunion, and subsequent revision with free VFF were included. Data on patient demographics, oncologic characteristics, surgical procedures, intraoperative details, postoperative complications, and time to graft union were recorded. Results Five patients (average age = 8.4 years; range = 5–10 years at surgery date) underwent secondary limb salvage procedure with free VFF reconstruction following failed CPH reconstruction for proximal humeral osteosarcoma (n = 4) or Ewing sarcoma (n = 1). The mean follow-up was 3.7 years. Complications occurred in five patients (100%), with three patients requiring reoperation (60%). Four patients achieved graft union (average union time = 3.7 months) and successful limb reconstruction. Four patients were alive with no local recurrence of the disease. One patient did not achieve union and was lost to follow-up. Conclusion Primary bone tumors in the pediatric population require wide surgical resection, and reconstruction often has high complication rates that can warrant further procedures. A free VFF is a viable option for upper extremity salvage after previously failed reconstructions because it provides vascularized tissue to a scarred tissue bed and allows for the replacement or augmentation of large bony defects.

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游离带血管腓骨修复小儿肉瘤CPH失败的疗效

背景由于预期寿命的延长和最近手术技术的改进，保肢已经取代截肢成为金标准，目前90%至95%的上肢恶性肿瘤都在进行保肢手术。然而，这些挽救性手术中的许多都与严重的术后并发症有关。特别是，肱骨前锁骨（CPH）手术与高骨不连发生率有关。我们介绍了在儿科人群中，在原始CPH手术失败或不愈合后，使用游离血管腓骨皮瓣（VFF）挽救上肢的经验。方法对5例18岁以下诊断为上肢肉瘤的患者进行了肿瘤切除并立即进行CPH重建并伴有骨不连，随后用游离VFF进行翻修。记录患者人口统计数据、肿瘤学特征、手术程序、术中细节、术后并发症和移植物愈合时间。结果5名患者（平均年龄 = 8.4年；范围 = 术后5-10年）在肱骨近端骨肉瘤CPH重建失败后，接受了二次保肢手术，并进行了游离VFF重建（n = 4）或尤因肉瘤（n = 1）。平均随访3.7年。并发症发生在5名患者中（100%），其中3名患者需要再次手术（60%）。4名患者实现移植物愈合（平均愈合时间 = 3.7个月）和成功的肢体重建。4名患者存活，无局部复发。一名患者没有达到愈合，失去了随访。结论儿童原发性骨肿瘤需要广泛的手术切除，重建往往并发症发生率高，需要进一步手术。在先前重建失败后，游离VFF是一种可行的上肢挽救选择，因为它为瘢痕组织床提供了血管化组织，并允许替换或扩大大型骨缺损。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sarcoma Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.00

自引率

0.00%

发文量

审稿时长

14 weeks

期刊介绍： Sarcoma is dedicated to publishing papers covering all aspects of connective tissue oncology research. It brings together work from scientists and clinicians carrying out a broad range of research in this field, including the basic sciences, molecular biology and pathology and the clinical sciences of epidemiology, surgery, radiotherapy and chemotherapy. High-quality papers concerning the entire range of bone and soft tissue sarcomas in both adults and children, including Kaposi"s sarcoma, are published as well as preclinical and animal studies. This journal provides a central forum for the description of advances in diagnosis, assessment and treatment of this rarely seen, but often mismanaged, group of patients.