Hideo Hasegawa1, Shinji Tsukamoto2, Kanya Honoki1, Takamasa Shimizu1, Lorenzo Ferra3, Costantino Errani3, Spyros Sioutis4, Andreas F Mavrogenis4, Yasuhito Tanaka1. 1. Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan. 2. Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan. shinji104@mail.goo.ne.jp. 3. Department of Orthopaedic Oncology, IRCCS Rizzoli Institute, Bologna, Italy. 4. Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Abstract
PURPOSE: Pedicle or free-flap reconstruction is important in surgical sarcoma management. Free flaps are indicated only when pedicle flaps are considered inadequate; however, they are associated with a higher risk of flap failure, longer surgical times, and technical difficulty. To determine the skin defect size that can be covered by a pedicle flap, we investigated the clinical outcomes and complications of reconstruction using pedicle flaps vs. free flaps after sarcoma resection. METHODS: We retrospectively studied the medical records of 24 patients with soft-tissue sarcomas who underwent reconstruction using a pedicle (n = 20) or free flap (n = 4) following wide tumour resection. RESULTS: All skin defects of the knee, lower leg, and ankle were reconstructed using a pedicle flap. Skin defects of the knee, lower leg, and ankle were covered by up to 525 cm2, 325 cm2, and 234 cm2, respectively. The amount of blood loss was significantly greater in the free-flap group than in the pedicle flap group (p = 0.011). Surgical time was significantly shorter in the pedicle flap group than in the free-flap group (p = 0.006). Total necrosis was observed in one (25%) patient in the free-flap group; no case of total necrosis was observed in the pedicle flap group. CONCLUSION: Less blood loss, shorter surgical time, and lower risk of total flap necrosis are notable advantages of pedicle flaps over free flaps. Most skin defects, even large ones, of the lower extremities following sarcoma resection can be covered using a single pedicle flap or multiple pedicle flaps.
PURPOSE: Pedicle or free-flap reconstruction is important in surgical sarcoma management. Free flaps are indicated only when pedicle flaps are considered inadequate; however, they are associated with a higher risk of flap failure, longer surgical times, and technical difficulty. To determine the skin defect size that can be covered by a pedicle flap, we investigated the clinical outcomes and complications of reconstruction using pedicle flaps vs. free flaps after sarcoma resection. METHODS: We retrospectively studied the medical records of 24 patients with soft-tissue sarcomas who underwent reconstruction using a pedicle (n = 20) or free flap (n = 4) following wide tumour resection. RESULTS: All skin defects of the knee, lower leg, and ankle were reconstructed using a pedicle flap. Skin defects of the knee, lower leg, and ankle were covered by up to 525 cm2, 325 cm2, and 234 cm2, respectively. The amount of blood loss was significantly greater in the free-flap group than in the pedicle flap group (p = 0.011). Surgical time was significantly shorter in the pedicle flap group than in the free-flap group (p = 0.006). Total necrosis was observed in one (25%) patient in the free-flap group; no case of total necrosis was observed in the pedicle flap group. CONCLUSION: Less blood loss, shorter surgical time, and lower risk of total flap necrosis are notable advantages of pedicle flaps over free flaps. Most skin defects, even large ones, of the lower extremities following sarcoma resection can be covered using a single pedicle flap or multiple pedicle flaps.
Authors: Caroline E Payne; Stefan O P Hofer; Toni Zhong; Anthony C Griffin; Peter C Ferguson; Jay S Wunder Journal: J Plast Reconstr Aesthet Surg Date: 2013-02-21 Impact factor: 2.740
Authors: Emily Z Keung; Alexander J Lazar; Keila E Torres; Wei-Lien Wang; Janice N Cormier; B Ashleigh Guadagnolo; Andrew J Bishop; Heather Lin; Kelly K Hunt; Justin Bird; Valerae O Lewis; Shreyaskumar R Patel; Jennifer A Wargo; Neeta Somaiah; Christina L Roland Journal: BMC Cancer Date: 2018-09-24 Impact factor: 4.430