VEZANI MUSKULOKUTANI REŽANJ TRAPEZIUSA U REKONSTRUKCIJI DEFEKTA U REGIJI RAMENA NAKON RESEKCIJE MEKOTKIVNOG SARKOMA – PRIKAZ SLUČAJA I PREGLED LITERATURE

Bojan Petrović; Stanislav  Rajković; Nikola  Bogosavljević; Milan  Stajić; Lazar Mičeta

doi:10.5937/smclk5-49043

Bojan Petrović Institut za ortopediju Banijca
Stanislav Rajković Institut za ortopediju ’’Banjica’’, Beograd
Nikola Bogosavljević Institut za ortopediju ’’Banjica’’, Beograd
Milan Stajić Institut za ortopediju ’’Banjica’’, Beograd
Lazar Mičeta Institut za ortopediju ’’Banjica’’, Beograd

DOI: https://doi.org/10.5937/smclk5-49043

Ključne reči: lejomiosarkom, resekcija tumora, granice resekcije, rekonstruktivna hirurgija

Sažetak

Uvod: Mekotkivni sarkomi (MTS) na ekstremitetima zahtevaju kompleksno lečenje koje podrazumeva hirurgiju očuvanja ekstremiteta uz adjuvantnu terapiju. Lečenje uključuje resekciju tumora sa širokim granicama uz dodatnu zračnu i/ili hemioterapiju. Pored resekcije tumora, važan segment predstavlja i rekonstrukcija nastalog mekotkivnog defekta. Za obimne rekonstruktivne procedure na gornjim ekstremitetima literatura sugeriše upotrebu slobodnih ili vezanih režnjeva. U regiji ramena, zbog složene regionalane anatomije, odabir adekvatnog režnja je hirurški imperativ. U poslednje vreme postoji veliko interesovanje za upotrebu vezanog muskulokutanog režnja m. trapezius-a, koji ima određene prednosti u odnosu na ostale režnjeve.

Prikaz slučaja: Pacijentkinja (31 godina) sa MTS-om u predelu levog ramena, tri puta je operativno lečena. Prvi put je učinjena intraleziona procedura – R2 resekcija, kada je ustanovljen pleomorfni dermalni sarkom. Nakon pet meseci, na osnovu nalaza nuklearne magnetne rezonance (NMR) konstatovan je rest-recidiv u predelu operativnog ožiljka. Učinjena je resekcija tumora, a mekotkivni defekt pokriven je slobodnim kožnim transplantatom parcijalne debljine kože po Tiršu. Patohistološki je dijagnostikovan visokogradusni lejomiosarkom. Nakon dva meseca od druge operacije NMR-om je potvrđen recidiv. Sprovedena je široka resekcija tumora, a mekotkivni defekt je pokriven vezanim donjim muskulokutanim režnjem trapezastog mišića.

Zaključak: Literatura oskudeva radovima koji opisuju rezultate primene režnja trapezastog mišića u rekonstrukciji defekata u regiji ramena nakon resekcije MTS-a. Takođe, ne postoji jednoglasni zvanični stav o širini granica resekcije koje se smatraju sigurnim. Ishod lečenja naše pacijentkinje ukazuje na veliki potencijal i prednosti režnja trapezastog mišića u poređenju sa drugim režnjevima iz te regije.

Biografije autora

Bojan Petrović, Institut za ortopediju Banijca

Specijalista ortopedije sa traumatologijom

Stanislav Rajković, Institut za ortopediju ’’Banjica’’, Beograd

Specijalista ortopedije sa traumatologijom

Klinički asistent na predmetu ortopedije sa traumatologijom

Nikola Bogosavljević, Institut za ortopediju ’’Banjica’’, Beograd

Specijalista ortopedije sa traumatologijom

Klinički asistent na predmetu ortopedije sa traumatologijom

Milan Stajić, Institut za ortopediju ’’Banjica’’, Beograd

Specijalista plastične i rekonstruktivne hirurgije

Lazar Mičeta, Institut za ortopediju ’’Banjica’’, Beograd

specijalizant ortopedske hirurgije i traumatologije

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