头皮恶性肿瘤切除后创面的皮瓣修复

Flap transposition in treatment of wound secondary to excision of malignant scalp tumors

目的探讨利用皮瓣转移修复头皮恶性肿瘤切除后创面的疗效。方法对38例头皮恶性肿瘤患者(鳞状细胞癌25例、基底细胞癌9例、黑色素瘤2例、疣状癌2例)实施肿瘤扩大切除术(切口距肿瘤边缘3～5cm,其中17例切除局部颅骨,10例切除局部硬脑膜,5例行同侧颈部淋巴清扫)。肿瘤切除后创面采用皮瓣转移修复(24例采用一个单蒂头皮瓣,6例采用多个单蒂头皮瓣,3例采用双蒂头皮瓣,3例采用下斜方肌皮瓣,2例采用背阔肌皮瓣)。硬脑膜缺损采用阔筋膜修补,颅骨缺损暂不修补。供瓣区直接缝合或中厚植皮修复结果其中31例患者皮瓣血运完全正常,另7例患者共8个皮瓣出现皮瓣远端静脉回流障碍,经高压氧治疗后皮瓣最终存活。所有患者供瓣区愈合好或植皮全部存活。患者对疗效均感满意。术后随访6个月～3年,未见肿瘤复发。结论利用皮瓣转移修复头皮恶性肿瘤切除后创面的疗效基本满意。

[Objective] To study the therapeutic effect of flap transposition in the treatment of wound secondary to the excision of malignant scalp tumors. [Methods] 38 patients with malignant scalp tumors（25 patients with squamous cell carcinoma, 9 patients with basal cell carcinoma, 2 patients with melanoma and 2 patients with verrucous carcinoma） were admitted and the tumors were resected thoroughly （3～5 cm away from the verge of the tumors）. Among all patients, 17 were operated with the skull resected partially, 10 were operated with the endocranium resected partially, and 5 were operated with the homolateral lymph nodes of neck resected completely. The defect of scalp in all patients was repaired by flap transposition （24 patients with a single-pedicle scalp flap, 6 patients with two or more single-pedicle scalp flaps, 3 patients with a double-pedicle scalp flap, 3 patients with trapezius myocutaneous flap, and 2 patients with latissimus dorsal myocutaneous flap）. The defect of endocranium was repaired with fascia lata while the defect of skull was not repaired according to pre-operation plan. The donor sites of flaps were sutured directly or repaired by skin graft. [Results] The flaps in 31 patients recovered completely. 8 flaps in the other 7 patients were not that well with the block of venous return in the distal end of the flaps, but survived ultimately by hyperbaric oxygen treatment. The donor sites of flaps in all patients healed completely by suturation or skin graft. All patients were satisfied with the therapeutic effect. No recurrence of tumors was observed in all patients after the post-operation follow-up visit, which lasted for 6 months to 3 years. [Conclusions] Flap transposition is a preferable choice for reconstructing the defect of scalp secondary to the excision of malignant scalp tumors.