CLINICAL ANALYSIS OF TUMOR PROSTHESIS REPLACEMENT COMBINED WITH AUTOLOGOUS SKIN FLAP TRANSPLANTATION FOR TREATMENT OF TIBIAL MALIGNANT TUMOR

Abstract

Objective: To investigate the effect of tumor prosthesis replacement combined with autologous skin flap transplantation for the treatment of tibial malignant tumors. Methods: A retrospective analysis was performed on 8 patients, including 5 males and 3 females, who received limb salvage surgery for tibial malignant tumor in Affiliated Hospital of Zunyi Medical University from October 2015 to October 2021. The age range was 27-65 years, with an average age of 32.5 years. 2 patients were diagnosed with osteosarcoma of the upper tibia, 1 patient with osteosarcoma of the middle tibia, 1 patient with Ewing's sarcoma of the upper tibia, and 4 patients with synovial sarcoma of the upper tibia. In all cases, subcutaneous and skin tissues in front of tibia were invaded by tumors. All patients were treated with neoadjuvant  chemotherapy  2  times  before  surgery.  Chemotherapy  regimen: osteosarcoma(AP, HD-MTX, IFO)；synovial sarcoma(AI)；Ewing's sarcoma(IE,VAC). Surgical strategy: Enlarged resection of tibial tumor+ Tumor prosthesis replacement+ autologous skin flap transplantation. Results: All 8 patients were followed up for 3-58months, with an average of 15.2 months. The average area of transplanted flaps was 18cm2, ranging from 16 to 22 cm2. Mean preoperative MSTS score was 16.3 (range 12-18), mean postoperative MSTS score was 24.8 (range 23-27). Tumor-related complications: no local recurrence or distant metastasis occurred during the follow-up period. Skin flap related complications: 1 patient developed local ischemic necrosis of the flap, and the wound healed after debridement and local skin grafting. Prosthesis-related complications: 1 patient developed late infection and underwent lower femur amputation. Conclusions: Extensive surgical resection of tibial malignant tumor is beneficial to obtain satisfactory negative surgical margin and reduce the risk of tumor recurrence. Postoperative function can be effectively restored by rebuilding bone structure with tumor prosthesis replacement. Intraoperative musculocutaneous flap transplantation can provide immediate coverage of prosthesis and wound and effectively reduce the risk of infection.