PDF(Pubmed)
Abstract：
Background: Nowadays, limb-sparing procedures are the gold standard in the treatment of soft-tissue sarcomas of the limbs. Wide tumor resection with appropriate oncological margins, reconstruction, and stabilization of the involved bone and joint and restoration of the soft tissue lost are essential in order to obtain good clinical and functional outcomes. Tumor excision and soft-tissue reconstruction performed in one-step surgery is chosen by many centers as the preferred approach; however, according to our experience in some selected patients, two-step surgery performed using a dermal regeneration template first and then a margin revision, taking into account the definitive results of the anatomopathological exam conducted over the surgical specimen from the previous surgery, associated with definitive reconstruction surgery over a healthy bed of granulated tissue, showed many potential benefits. Methods: A retrospective observational study was conducted on thirteen patients who underwent a two-step reconstruction procedure using dermal substitution after soft-tissue sarcoma excision. Results: Clinically, the enrolled patients achieved excellent contour and cosmesis of their surgical wounds, with a mean VSS value of 3.07. During the follow-up period, no local recurrences were observed in any patient. Conclusions: Two-step surgery represents the most suitable solution to allow surgical radicality with minimal recurrency and adequate soft-tissue reconstruction, avoiding the possibility of wasting autologous tissue. Our patients generally embraced this approach and the management that followed.
摘要：
背景：如今，保肢手术是治疗四肢软组织肉瘤的金标准。肿瘤广泛切除，肿瘤切缘合适，重建,为了获得良好的临床和功能结果，所涉及的骨骼和关节的稳定以及软组织丢失的恢复至关重要。许多中心选择在一步手术中进行的肿瘤切除和软组织重建作为首选方法；然而，根据我们对一些选定患者的经验，首先使用真皮再生模板进行两步手术，然后进行边缘翻修，考虑到对先前手术的手术标本进行的解剖病理学检查的最终结果，与在健康的颗粒组织床上进行明确的重建手术有关，显示了许多潜在的好处。方法：对13例软组织肉瘤切除术后使用真皮替代进行两步重建手术的患者进行了回顾性观察研究。结果：临床，入选的患者手术伤口达到了良好的轮廓和外观，平均VSS值为3.07。在后续期间,所有患者均未出现局部复发.结论：两步手术是最合适的解决方案，可以使手术根治性具有最小的复发和足够的软组织重建，避免浪费自体组织的可能性。我们的患者普遍接受这种方法和随后的管理。
