目的:活动脊柱和骶骨原发性肿瘤的手术通常需要复杂的重建技术来覆盖软组织缺损并治疗伤口和脑脊液相关并发症。解剖学,血管,大网膜的免疫调节特性使其成为处理放射性软组织损伤的优良局部基质,感染,和广泛的伤口缺陷。这项研究描述了作者在使用带蒂网膜皮瓣覆盖可移动脊柱和骶骨原发性肿瘤手术缺损的复杂伤口重建中的经验。
方法:对2010年至2020年间34例原发性骶骨和活动期脊柱肿瘤整块切除后行带蒂网膜瓣重建的患者进行了回顾性队列分析。这项研究的重点是评估网膜瓣使用的适应症,包括软组织覆盖,防止术后放射治疗,感染管理,骨移植的血管供应,硬脑膜缺损和脑脊液渗漏修复。患者人口学特征,肿瘤特征,手术结果,并对随访数据进行分析,以确定手术的疗效和并发症发生率。
结果:从2010年到2020年,34例患者在骶骨(34例[71%]中的24例)和可移动脊柱(34例[29%]中的10例)原发肿瘤整块切除后接受了带蒂网膜瓣重建,主要是脊索瘤.患者队列包括21名男性和13名女性,中位(范围)年龄为60(32-89)岁。大网膜瓣最常见的适应症是软组织覆盖(34个中的20个[59%])。其他适应症包括保护腹盆腔器官进行术后放射治疗(34个中的6个[18%]),治疗感染(34个中的5个[15%]),为游离腓骨移植提供血管供应(34[3%]中的1个),并修复大的硬脑膜缺损和脑脊液渗漏(34个中的2个[6%])。中位(范围)随访24(0-132)个月,在此期间,71%(34例中的24例)的患者不需要因伤口相关并发症而进行额外手术。在最后的随访中,59%(34人中的20人)疾病稳定,32%(34人中的11人)复发,有疾病进展,或治疗后已出院到临终关怀。
结论:带蒂网膜是一种有效的局部组织移植物,可用于原发性脊柱肿瘤的复杂伤口重建和高风险闭合处理。与其他方法相比,该技术的并发症发生率较低,并且在具有挑战性的情况下可能会影响手术计划和皮瓣选择。
OBJECTIVE: Surgery for primary tumors of the mobile spine and sacrum often requires complex reconstruction techniques to cover soft-tissue defects and to treat wound and CSF-related complications. The anatomical, vascular, and immunoregulatory characteristics of the omentum make it an excellent local substrate for the management of radiation soft-tissue injury, infection, and extensive wound defects. This study describes the authors\' experience in complex wound reconstruction using pedicled omental flaps to cover defects in surgery for mobile spine and sacral primary tumors.
METHODS: A retrospective cohort analysis was conducted on 34 patients who underwent pedicled omental flap reconstruction after en bloc resection of primary sacral and mobile spine tumors between 2010 and 2020. The study focused on assessing the indications for omental flap usage, including soft-tissue coverage, protection against postoperative radiation therapy, infection management, vascular supply for bone grafts, and dural defect and CSF leak repair. Patient demographic characteristics, tumor characteristics, surgical outcomes, and follow-up data were analyzed to determine the procedure\'s efficacy and complication rates.
RESULTS: From 2010 to 2020, 34 patients underwent pedicled omental flap reconstruction after en bloc resection of sacral (24 of 34 [71%]) and mobile spine (10 of 34 [29%]) primary tumors, mostly chordomas. The patient cohort included 21 men and 13 women with a median (range) age of 60 (32-89) years. The most common indication for omental flap was soft-tissue coverage (20 of 34 [59%]). Other indications included protecting abdominopelvic organs for postoperative radiation therapy (6 of 34 [18%]), treating infections (5 of 34 [15%]), providing vascular supply for free fibular bone graft (1 of 34 [3%]), and repairing large dural defects and CSF leak (2 of 34 [6%]). The median (range) follow-up was 24 (0-132) months, during which 71% (24 of 34) of patients did not require additional surgery for wound-related complications. At last follow-up, 59% (20 of 34) had stable disease and 32% (11 of 34) had recurrence, had progression of disease, or had been discharged to hospice after treatment.
CONCLUSIONS: The pedicled omentum is an effective local tissue graft that can be used for complex wound reconstruction and management of high-risk closures in primary spine tumors. This technique may have a lower rate of complications than other approaches and may influence surgical planning and flap selection in challenging cases.