Application Of Medial Head Gastrocnemius Transposition Flap To Limb-salvage Operation Proximal Tibial Malignant Tumor.

Objective: To use the medial head gastrocnemius muscle flap to reconstruct the soft tissue in the limb-salvage operation of the proximal tibia with malignant tumors, then evaluate the clinical application effect in the lower postoperative incision complications and improving limb function.Methods: From January 2002 to June 2009, 34 patients (24 males, 10females; aged 9-43years, averaged 20.97years) sufferings from the proximal tibial malignant tumors were treated with a limb-salvage operation. The pathology result: 27 patients with osteosarcoma, 1 with synovial sarcoma, 2 with malignant fibrous histocytoma, 1with Ewing's sarcoma, 1with liposarcoma, 1with chondrosarcoma.Assessment of bone and soft tissue has been the extent of tumor invasion according to patients'clinical symptoms and signs, combined with X-ray, CT, MRI, ECT, CTA or MRA. According to the Enneking staging system, 5 cases in StageⅡA,27 in StageⅡB,2 in StageⅢA. One or two cycles of neoadjuvant chemotherapy were used to each of the patients before operation.All cases of tumor resection for 10 ~ 17cm length, average 13.07 cm .Cut off tumor organization and its boundary in the surgical operation 5 cm outside skeleton and muscular tissue. Among them, 32 patients use the artificial knee joint displacement operation, 2 use the transplant with splinter bone operation. 22 patients underwent the medial head of the gastrocnemius muscle flap transpositiom to reconstruct the soft tissues after resection of the tumors and reconstruction of the bone defect byprosthesis.After surgery according to whether the use of muscle flap for reconstruction of soft tissue cases were divided into two groups, whether there were observed in patients with wound complications, and use Enneking Musculoskeletal tumor surgery in patients with lower extremity functional evaluation criteria for assessment of lower limb function, the use of SAS V8.0 statistical software used for statistical analysis, using the exact probability method were compared risk of wound complications in patients whether there are differences, using rank-sum test to compare the two groups of patients after lower limb function whether there are differences.Results: The follow-up for 2-24 months after the operation. 3 cases have poor wound healing in 22 patients who operate with the transposition of medial gastrocnemius muscle flap. 6 cases have poor wound healing in 12 patients who didn't operate with it. The result of Fisher's exact test is that P=0.0403<0.05. So the incidence of postoperative wound complications is different between two groups. The group of the incidence of wound complications which operated with the transposition of muscle flap is lower than the other one.According to whether under a retention of limb pain, functional activity, patient satisfaction, load-bearing way, walking ability and gait six areas to evaluate lower limb function. Overall score of 46.7% -80%.The group which didn't operate with the transposition of muscle flap is an average score of 63.77%, the other group is an average score of 68.64﹪. According to the function assessment by the Enneking system, the result of Wilcoxon scores (ranks of data) is that P=0.0411<0.05. So the lower limb function scores between two groups are different. The scores of the group which operated with the transposition of muscle flap are higher than the other one.Conclusions: In the proximal tibial malignant bone tumor in patients with limb-salvage surgery, the use of gastrocnemius flap-line incision of soft tissue reconstruction can reduce the incidence of complications. Use of muscle flap reconstruction of soft tissue defects is simple, appropriate muscle belly size, but also large enough rotation arc, for the area function is not affected; can also promote the local blood supply, reducing necrosis, infection and the incidence of unhealed and will not affect the prosthetic replacement an early stage after radiotherapy and chemotherapy, prevention and control problems due to delay in wound treatment, thereby enhancing the survival rate. It is a simple, practical and effective surgical method.On the postoperative function of lower limbs, the patients who operated with the muscle flap whose lower limb function is better than those who did not operated with it; muscle flap transfer of patients after surgery can enhance the stability of the knee, providing a permanent biological extensor device to connect, better recovery of limb function, improve prosthesis lifetime.