足跟部恶性黑色素瘤的切除与修复重建

RESECTION AND REPARATION OF HEEL WITH MALIGNANT MELANOMA

目的探讨足跟部恶性黑色素瘤的手术切除和修复重建的原则。方法2001年5月～2003年12月收治8例恶性黑色素瘤,其中男5例,女3例。年龄28～56岁。病变均位于足跟部,病理检查均证实为恶性黑色素瘤;Breslow分级:级2例,级5例,级1例。手术行局部广泛切除,根据足跟部软组织缺损大小,分别选用足外侧皮瓣、足底内侧皮瓣及腓肠神经营养血管逆行皮瓣移位修复,并于术前、术后应用干扰素治疗。结果术后8例皮瓣全部成活,随访1年6个月～4年,患者均健在,肿瘤未见复发。在功能及感觉恢复方面,足底内侧皮瓣与足外侧皮瓣最佳,腓肠神经营养血管逆行皮瓣恢复良好。结论足跟部恶性黑色素瘤应行局部广泛切除术,在切缘阴性的基础上进行修复重建,根据创面大小分别采用足外侧皮瓣、足底内侧皮瓣及腓肠神经营养血管逆行皮瓣移位修复,临床疗效满意。

Objective To investigate the surgical resection and reparation of heel with malignant melanoma. Methods Eight patients with malignant melanoma were treated from May 2001 to December 2003. The patients included 5 males and 3 females, and their ages ranged from 28 to 56 years. All lesions were located in the heel and were proved by pathological examination. According to Breslow classification, there were 2 cases of Grade Ⅰ, 5 cases of Grade Ⅱ, and 1 case of Grade Ⅲ. Local extensive resection was performed in all cases. Lateral pedal skin flap, plantar medial artery island skin flap, and retrograde skin flap supplied by sural nutrition blood vessel were respectively applied in the reparation according to the size of heel soft tissue defect. The treatment with interferon was delivered before and after the operation. Results The surgical reparation was successful in all 8 cases. The postoperative follow-up was conducted from 18 months to 4 years. All patients remained alive and no tumor recurrence was observed. Considering the recovery of the function and sense, the best result was acquired with plantar medial artery island skin flap and lateral pedal skin flap, good with retrograde skin flap supplied by sural nutrition blood vessel. Conclusion Local extensive resection is essential for the heel with malignant melanoma. Reparative reconstruction should be made on negative operative margin. Satisfactory clinical outcome is achieved by using lateral pedal skin flap, plantar medial artery island skin flap, and retrograde skin flap supplied by sural nutrition blood vessel.