全上唇皮肤缺损修复的临床研究

Clinical study of reconstruction of the total upper lip skin defect

目的:探讨和总结全上唇皮肤缺损的修复方法。方法:自2002年9月起,我科共收治各种原因造成的全上唇皮肤缺损患者73例,分别应用皮片游离移植、鼻唇沟局部皮瓣转移、额部扩张皮瓣带蒂转移、头皮扩张皮瓣带蒂转移、上臂管形皮瓣和向上臂延伸的肩胛皮瓣转移修复。结果:73例中有6例出现术后并发症;1例为扩张器注水过程中出现扩张器渗露,余5例为皮瓣转移术后出现皮瓣血运障碍,其中,鼻唇沟局部皮瓣出现血运障碍1例,额部单蒂皮下蒂扩张皮瓣出现血运障碍4例,仅1例出现皮瓣远端1/3皮肤坏死。术后随访6个月以上患者45人,除植皮术后患者均出现不同程度的皮片挛缩和色泽深暗外,皮瓣成活良好,效果稳定。结论:全上唇皮肤缺损修复方法很多,各种方法各有相应的适应证和优缺点,需综合各种因素,择优而用。

Objective To explore and summarize the methods of reconstruction of total upper lip skin defects. Methods 73 patients of total upper lip skin defects have been treated in our department since September, 2002. The methods which we used include free skin grafting, local bilateral nasolabial flap, expanded forehead flap, expanded scalp skin flap, upper limb tubed skin flap and scapular skin flap extending to the upper arm. Results Complications occurred in 6 cases of all 73 patients. Expander effusion occurred in 1 patient. Vascular disturbance occurred in 5 flap operations which include one local nasolabial flap and four subcutaneous monopedicled forehead flap. Flap necrosis only occurred in one patient. 45 cases were followed up more than 6 months. Results of flap operations is steady while contracture and dark color has been observed in. skin grafting patients. Conclusion There are multiple reconstructive methods of upper lip skin defect. Each method owns its corresponded indication, advantage and disadvantage. The ideal method to a selected patient should be made according to the characteristics of each patient.