Background: Reconstruction of the thigh extensor mechanism following wide excision of a soft-tissue sarcoma is difficult. The aim of this study was to describe the outcomes following complete quadriceps resection for large high-grade soft-tissue sarcomas. Methods: Ten patients with AJCC grade IIIB soft-tissue sarcomas of the anterior thigh were treated with total wide margin quadricectomy, with a mean follow-up of 4 years (range: 51–163 months) in the five surviving patients with conservative surgical procedures. The minimum follow-up period for four of these patients was 8 years. The extensor mechanism was reconstructed with local muscle transfers (eight cases) or a neurotized free flap of the contralateral vastus lateralis (two cases). Results: Four patients died, two due to non-tumor related causes and two due to metastatic disease at 50 months and 43 months. The remaining six were alive and disease-free at the final follow-up. All patients received surgical revision due to wound necrosis. Another patient required an external hemipelvectomy due to early local recurrence of the disease. Functional results of the five patients who remained alive and retained their limb were good or excellent in two cases, acceptable in one, and poor in two, according to their MSTS scores. Average knee flexion was 80° (range: 10–150°). Passive extension was complete in all cases, though no patients achieved it actively. Extensor strength was 2/5 in four patients and 4/5 in the other. Conclusion: Total quadricectomy for high-grade soft-tissue sarcomas of the anterior thigh compartment ensures wide resection margins and local disease control, although local wound complications are common, particularly in older patients. Resection appears to be technically easier if performed distally to proximally in the thigh. Local muscle transfers are more suited for low-demand patients, while neurotized free muscle flaps are mainly an option for young, motivated patients.
背景：软组织肉瘤广泛切除后的大腿伸肌装置重建较为困难。本研究旨在描述因大型高级别软组织肉瘤行完全股四头肌切除术后的临床结局。方法：对10例AJCC IIIB级大腿前侧软组织肉瘤患者行全范围广泛切除的股四头肌切除术，其中5例接受保肢手术的存活患者平均随访4年（范围：51-163个月），其中4例患者最短随访期为8年。伸肌装置通过局部肌肉转移（8例）或对侧股外侧肌神经化游离皮瓣（2例）进行重建。结果：4例患者死亡，其中2例死于非肿瘤相关原因，2例分别于术后50个月和43个月死于转移性疾病。其余6例患者在末次随访时存活且无病。所有患者均因伤口坏死接受手术翻修。另1例患者因疾病早期局部复发需行外部半骨盆切除术。根据MSTS评分，5例存活且保留肢体的患者中，功能结果优或良者2例，可接受者1例，差者2例。平均膝关节屈曲度为80°（范围：10-150°）。所有病例被动伸展均完全，但无患者能主动完成。伸肌力量4例为2/5级，1例为4/5级。结论：针对大腿前侧间室高级别软组织肉瘤的全股四头肌切除术可确保广泛切除边界和局部疾病控制，但局部伤口并发症常见，尤其在老年患者中。若采用从大腿远端向近端的手术方式，切除在技术上似乎更为简便。局部肌肉转移更适用于低需求患者，而神经化游离肌皮瓣主要适用于年轻且有积极康复意愿的患者。
肿瘤(癌症)患者之家