摘要
目的探讨应用各种游离皮瓣修复头皮恶性肿瘤切除术后较大范围缺损的可行性和临床效果。方法2012年3月-2015年1月,采用游离皮瓣修复18例头皮恶性肿瘤切除术后皮肤软组织缺损。其中男13例,女5例;年龄18~72岁,平均49岁。鳞癌17例(均有瘢痕病史),隆突性纤维肉瘤1例。肿瘤扩大切除后缺损范围为15 cm×12 cm^22 cm×17 cm,切取皮瓣大小为17 cm×14 cm^24 cm×19 cm,其中应用股前外侧皮瓣5例,背阔肌肌皮瓣6例,胸背动脉穿支皮瓣3例,背阔肌肌瓣结合中厚植皮4例(肌瓣游离移植术后5~7 d行二期植皮)。皮瓣供区均植皮修复,肌瓣供区直接缝合。结果术后游离皮瓣成活13例,坏死1例;游离肌瓣全部成活,二期植皮后因枕部压迫致移植皮片局部坏死1例,经二次植皮后愈合。供区均Ⅰ期愈合,无血肿、血清肿发生;植皮均顺利成活。患者均获随访,随访时间5~33个月,平均20个月。3例患者分别于术后5、7、13个月因肿瘤颅内转移死亡。2例患者局部复发,再次切除后采用局部皮瓣移位或植皮修复。术后皮瓣外观较满意,4例因皮瓣臃肿行二期修薄术。皮瓣耐磨性好,随访期内无破溃发生。背阔肌肌瓣切取后未遗留明显功能障碍。结论综合供、受区特点选择合适的游离皮瓣移植修复较大范围头皮恶性肿瘤切除术后缺损是一种有效方法。
Objective To investigate the effectiveness of different free flaps in the repair of large defects after resection of scalp malignant tumors. Methods Between March 2012 and January 2015, 18 patients with large defect after resection of scalp malignant tumors were treated with different free flaps. There were 13 males and 5 females with an average age of 49 years（range, 18-72 years）. There were 17 cases of squamous carcinoma and 1 case of dermatofibril sarcoma protuberans. The defect size ranged from 15 cm×12 cm to 22 cm×17 cm after resection of tumors. Defects were repaired with anterolateral thigh flap in 5 cases, latissimus dorsi myocutaneous flap in 6 cases, thoracodorsal artery perforator flap in 3 cases, and latissimusdorsi muscle flap plus intermediate split thickness skin graft in 4 cases. The flap size was 17 cm×14 cm to 24 cm×19 cm. The donor sites of the skin flap were covered with skin graft, while the donor sites of the muscle flap were directly sutured. Results Of 14 skin flaps, the other 13 flaps survived except 1 flap necrosis; all muscle flaps survived. The patients were followed up 5-33 months（mean, 20 months）. Three patients died because of intracranial metastasis at 5, 7, and 13 months after operation, respectively. Two patients had local recurrence and underwent secondary operation. The results of both appearance and function were satisfactory; secondary operation of thinning the flaps was performed in 4 cases of bulky flaps. The flaps had good wear resistance, without ulceration during follow-up. No obvious impairment was observed after harvesting latissimus dorsi myocutaneous flap. Conclusion Large scalp defects after malignant tumor resection can be effectively repaired by proper application of different free flaps.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2016年第1期87-90,共4页
Chinese Journal of Reparative and Reconstructive Surgery
