| Reconstruction after Wide Excision of Malignant Soft Tissue Tumor in Shoulder arm |
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Young Gu Lee, Jae Do Kim, Young Ho Kwon, Sang Won Cha |
| 견관절 및 상완에 발생한 연부 조직 악성 종양의 광범위 절제술 후 재건술 |
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이영구, 김재도, 권영호, 차상원 |
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| Abstract |
Purpose
To evaluate the clinical usability of reconstructive methods, and to determine how to select flap after wide excision of malignant soft tissue tumor in shoulder and arm. Materials and Methods: The nine cases shown in the seven patients (In case of a male patient, reconstructive operation was performed three times due to local recurrence.) with malignant soft tissue tumor in shoulder and arm underwent reconstruction after wide excision from May 2000 until September 2005. Oncologic, surgical and functional results were evaluated. Results: The defect, mean size was 16.5¡¿12.4 cm, was reconstructed with the cutaneous flap, mean size was 14.2¡¿9.4 cm, and split-thickness skin graft for the remnant. The mean operation time was 7.6(4.2~12) hours; it took 6.2 hours to reconstruct by rotation flap and skin graft, and 9.2 hours by free flap and skin graft. As oncologic results, 5 patients were remained diseasefree at the time of the last follow-up, 1 patient expired from pulmonary metastasis, 1 patient had local recurrence. As functional results, 7 patients were evaluated with average score of 78% using the system of the Musculoskeletal Tumor Society. Conclusion: The ipsilateral latissimus dorsi musculocutaneous rotation flap which is easy procesure, has less complication and takes short operation time, can be primarily considered to reconstruct large defects in shoulder and arm after wide excision of malignant soft tissue tumor. In shoulder girdle, tumor excision can cause three-dimensional defects and it can be covered by combined latissimus dorsi and serratus anterior muscle rotation flap. The anterolateral thigh free flap is effective in reconstruction of wide skin defects and the contralateral latissimus dorsi musculocutaneous free flap is useful in coverage of muscle and skin defects in shoulder and arm. |
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