目的回顾不同部位骨与软组织肿瘤切除术后软组织重建方法及临床疗效,探讨合理的软组织重建策略。方法 2003年6月-2010年12月,收治因骨或软组织肿瘤进行外科切除并接受皮瓣、肌瓣或肌皮瓣修复重建患者90例。其中男59例,女31例;年龄9～85岁,中位年龄37.2岁。骨原发或转移性肿瘤52例,软组织原发肿瘤38例。75例为肿瘤切除后一期软组织重建;7例因伤口不愈合行清创后软组织重建;8例因伤口感染行清创、负压封闭引流,二期软组织重建。皮瓣类型:腓肠肌肌瓣40例,背阔肌肌(皮)瓣6例,腹直肌肌(皮)瓣4例,臀大肌肌皮瓣、胸大肌肌瓣、交腹皮瓣各1例,局部转移皮瓣27例,带血管蒂皮瓣5例,单纯游离植皮5例。皮瓣范围为6.5 cm×4.5 cm～21.0 cm×9.0 cm。结果术后87例皮瓣成活;Ⅰ期愈合81例;Ⅱ期愈合6例,其中2例皮瓣部分坏死,经换药后成活,3例皮瓣延迟愈合,1例伤口轻度感染,经保守治疗后愈合。软组织重建失败3例,均为皮瓣坏死合并感染,经清创二次皮瓣转移后愈合。供区创面均Ⅰ期愈合,移植皮片完全成活。73例获随访,随访时间10～102个月,平均36.1个月。6例患者于术后2～27个月,平均8.2个月出现局部复发并接受二次手术切除。13例于术后6～34个月,平均19.2个月死于原发病。结论骨与软组织肿瘤切除后常造成较大的软组织缺损,选择适当的肌(皮)瓣进行软组织重建可以达到理想的伤口闭合,减少术后伤口并发症,有利于术后功能恢复。 Objective To review the soft tissue reconstruction methods and clinical curative effect after resection of bony and soft tissue tumors in different parts and explore the reasonable strategy of soft tissue reconstruction. Methods From June 2003 to December 2010, 90 patients with bone or soft tissue tumors underwent surgical resection and received flap, muscle flap or myocutaneous flap reconstruction. There were 59 males and 31 females, aged 9-85 years, with a median age of 37.2 years. Bone primary or metastatic tumors in 52 cases, 38 cases of soft tissue tumors. Seventy-five cases were reconstructed with one-stage soft tissue after tumor resection. Seven cases were reconstructed with debridement after wound debridement. Eight cases were debrided with wound infection. Flap type: gastrocnemius muscle flap in 40 cases, latissimus dorsi muscle flap in 6 cases, rectus abdominis flap in 4 cases, gluteus maximus myocutaneous flap, pectoralis major muscle flap, 1 case, 27 cases of local transfer flap, 5 cases of vascular pedicle flap, 5 cases of simple free skin graft. Flaps range from 6.5 cm × 4.5 cm to 21.0 cm × 9.0 cm. Results 87 flaps survived after operation, 81 cases were cured in stage Ⅰ, 6 cases were cured in stage Ⅱ. Two of the flaps were partially necrotic, and survived after dressing change. Three cases developed delayed union and one case had mild wound infection. Conservative treatment after healing. Soft tissue reconstruction failed in 3 cases, both were necrosis of the flaps with infection, after debridement secondary flap healed. The donor sites were all healed in the first phase, and the transplanted skin completely survived. 73 cases were followed up for 10 to 102 months with an average of 36.1 months. 6 patients in 2 to 27 months after surgery, an average of 8.2 months, local recurrence and received a second surgical resection. Thirteen patients died of primary disease at an average of 19.2 months after 6 to 34 months. Conclusion Bone and soft tissue tumors often result in large soft tissue defects after resection. Choosing the appropriate musculocutaneous flap for soft tissue reconstruction can achieve ideal wound closure, reduce postoperative wound complications and facilitate postoperative functional recovery.