削薄游离皮瓣在修复肢体恶性肿瘤切除后创面中的临床效果

李斌; 杨勇; 栗鹏程; 杨发军; 童德迪; 王志新; 李峰; 王扬

doi:10.3760/cma.j.cn501225-20260426-00167

削薄游离皮瓣在修复肢体恶性肿瘤切除后创面中的临床效果

doi: 10.3760/cma.j.cn501225-20260426-00167

李斌¹,
杨勇^1, ,,
栗鹏程¹,
杨发军²,
童德迪¹,
王志新¹,
李峰¹,
王扬¹

1.
首都医科大学附属北京积水潭医院手外科,北京　100035
2.
首都医科大学附属北京积水潭医院骨肿瘤科,北京　100035

基金项目:

北京市医院管理中心“登峰”计划 DFL20240402

北京市卫生系统高层次卫生技术人才培养计划项目 2015-3-036

详细信息

通讯作者:
杨勇,Email：0414yang@sina.com

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出版历程
- 收稿日期: 2026-04-26
- 网络出版日期: 2026-08-03

Clinical efficacy of thinned free flaps for wound reconstruction after extremity malignant tumor resection

1.
Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
2.
Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China

Funds:

Beijing Hospitals Authority's Ascent Plan DFL20240402

Beijing Municipal Health System's High-Level Health Professional Training Program 2015-3-036

More Information

Corresponding author: Yang Yong, Email: 0414yang@sina.com

摘要

摘要: 目的探讨削薄游离皮瓣在修复肢体恶性肿瘤切除后创面中的临床效果。方法该研究为回顾性病例系列研究。2023年6月—2026年2月,首都医科大学附属北京积水潭医院手外科收治17例符合入选标准的肢体恶性肿瘤患者,其中男11例、女6例,年龄38~91岁,肿瘤位于上肢者9例、下肢者8例；属于鳞状细胞癌者6例、隆突性皮肤纤维肉瘤者2例、脂肪肉瘤者2例、滑膜肉瘤者2例、恶性周围神经鞘瘤者2例、上皮样肉瘤者1例、血管肉瘤者2例。行肿瘤广泛切除术,切除后创面均伴有深部组织外露,软组织缺损面积为4 cm×4 cm~24 cm×12 cm。采用削薄游离皮瓣进行创面修复,其中选用股前外侧皮瓣者7例、腹股沟皮瓣者6例、腓肠内侧动脉穿支皮瓣者2例、腹壁下动脉穿支皮瓣者1例、足底内侧皮瓣者1例。皮瓣切取面积为4 cm×4 cm~24 cm×13 cm,厚度为4~10 mm,平均5.8 mm。供区创面行直接缝合、局部接力皮瓣或植皮修复。记录术后皮瓣成活情况,以及受区感染、血肿、创面延迟愈合等发生情况；同时,记录供区创面愈合情况及并发症发生情况。末次随访时,综合评估皮瓣修复效果（优、良、差）。随访记录患者肿瘤预后。结果术后16例患者皮瓣颜色红润、皮温正常、毛细血管充盈反应正常,顺利成活；1例采用腹股沟皮瓣修复手背部血管肉瘤切除后缺损者,术后第3天皮瓣远端表皮坏死,经换药处理后愈合。所有皮瓣受区均未发生感染、血肿或创面延迟愈合。15例患者供区创面顺利愈合,2例供区创面延迟愈合,所有供区创面均无严重并发症。末次随访时,14例患者皮瓣修复效果评为优,3例为良。术后随访2~34个月,3例患者肿瘤局部复发,复发时间分别为术后24、10、3个月；2例患者发生肿瘤转移,分别为淋巴结转移和远处转移,转移时间均为术后11个月；其余12例患者未见局部复发或远处转移征象。结论采用削薄游离皮瓣修复肢体恶性肿瘤切除后创面,皮瓣成活率高,修复效果佳,供区并发症少。
- 四肢 /
- 肿瘤 /
- 软组织损伤 /
- 外科皮瓣 /
- 显微外科手术 /
- 削薄皮瓣
Abstract: Objective To evaluate the clinical efficacy of thinned free flaps in repairing soft tissue defects following resection of extremity malignant tumors. Methods This study was a retrospective case series study. From June 2023 to February 2026, 17 patients with extremity malignant tumors who met the inclusion criteria were admitted to the Department of Hand Surgery, Beijing Jishuitan Hospital of Capital Medical University. The cohort consisted of 11 males and 6 females, aged 38-91 years. Tumors were located in the upper extremity in 9 cases and in the lower extremityin 8 cases. Pathological diagnoses included squamous cell carcinoma (6 cases), dermatofibrosarcoma protuberans (2 cases), liposarcoma (2 cases), synovial sarcoma (2 cases), malignant peripheral nerve sheath tumor (2 cases), epithelioid sarcoma (1 case), and angiosarcoma (2 cases). All patients underwent wide tumor resection, resulting in soft tissue defects with exposure of deep structures. The defect size ranged from 4 cm×4 cm to 24 cm×12 cm. Thinned free flaps were used for wound repair, including anterolateral thigh flaps (7 cases), groin flaps (6 cases), medial sural artery perforator flaps (2 cases), deep inferior epigastric artery perforator flaps (1 case), and medial plantar flaps (1 case). The flap size ranged from 4 cm×4 cm to 24 cm×13 cm, with a thickness of 4-10 mm (with mean of 5.8 mm). Donor sites were closed by direct suture and local relay flap or skin grafting. Postoperative flap survival and recipient site complications (infection, hematoma, delayed wound healing, etc.) were recorded, along with donor site healing status and associated complications. A comprehensive assessment of reconstructive outcomes (excellent, good, and poor) was conducted at the final follow-up. Tumor prognosis of all patients was tracked and documented. Results Sixteen flaps survived completely with ruddy color, normal skin temperature, and intact capillary refill. One patient who underwent groin flap reconstruction for a defect 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 routine dressing changes. No infection, hematoma, or delayed wound healing occurred in any recipient site. Donor sites healed uneventfully in 15 patients, while 2 patients experienced delayed healing. No major complications were observed in any donor site. At the last follow-up, the 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 occurred in 3 patients at 24, 10, and 3 months postoperatively, respectively. Metastasis (lymph node and distant) occurred in 2 patients at 11 months postoperatively in both cases. The remaining 12 patients showed no evidence of local recurrence or distant metastasis. Conclusions Thinned free flaps are effective for reconstructing wounds following extremity malignant tumor resection, with a high flap survival rate, satisfactory reconstructive outcomes, and low donor-site morbidity.
- Extremities /
- Neoplasms /
- Soft tissue injuries /
- Surgical flaps /
- Microsurgery /
- Thinned flap
李斌：研究酝酿和设计、论文撰写和修改、手术实施、数据收集；杨勇：研究酝酿和设计、论文修改、手术实施、研究指导、经费支持；栗鹏程、杨发军、童德迪、王志新、李峰、王扬：手术实施、数据收集

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参考文献(40)

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图 1 采用削薄游离股前外侧皮瓣修复例1患者手背鳞状细胞癌切除后创面的效果。1A.入院时手背鳞状细胞癌情况；1B.对肿瘤行广泛切除后的创面情况；1C.设计股前外侧削薄皮瓣；1D.切取皮瓣即刻；1E.皮瓣移植后即刻；1F.术后2周,皮瓣存活良好；1G.术后33个月,手背皮瓣外形；1H.术后33个月,大腿供区恢复情况

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图 2 采用削薄游离股前外侧皮瓣修复例2患者足背上皮样肉瘤切除后创面的效果。2A.术前足背肿瘤破溃出血情况；2B.术前患足冠状面的磁共振成像；2C.对肿瘤行广泛切除后的创面情况；2D.设计股前外侧削薄皮瓣；2E.皮瓣切取过程中,保留浅筋膜深层脂肪于供区；2F.术中掀起皮瓣后可见皮瓣厚度较薄；2G.游离皮瓣后即刻；2H.皮瓣移植后即刻,可见厚度适宜,无臃肿；2I.术后15个月,足背皮瓣外形良好；2J.术后15个月,供区创面愈合良好；2K、2L.分别为术后15个月,患足侧面、正面观X线片

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