局部皮瓣在头面部皮肤恶性肿瘤切除后创面修复中应用

Defects repairing with local flap in face and head after resection of malignant tumor

目的:探讨采用局部任意皮瓣修复头面部皮肤恶性肿瘤切除后形成的继发性创面的应用体会。方法:本组8例体表恶性肿瘤中,基底细胞癌5例,鳞状细胞癌3例,切除范围在边缘外5～15mm。缺损全部采用局部任意皮瓣修复,皮瓣长宽比为1～3:1,面积大于缺损部位10%～30%,切取深度面部为SMAS浅面,头部为帽状腱膜与颅骨骨膜之间。斧头状皮瓣3例,其中改良菱形皮瓣2例,鼻唇沟皮瓣1例,易位皮瓣1例,上唇组织推进皮瓣1例。结果:全部皮瓣存活良好,创面得以Ⅰ期修复,供瓣区继发创面除1例巨大、使用中厚植皮封闭外,余均能拉拢缝合。经3～8个月随访,局部外形满意,未见肿瘤复发。结论:考虑到美观的因素,只要具备适应证,局部任意皮瓣是头面部浅表恶性肿瘤切除后形成的创面修复的首选方法。

Objective To summarize clinical experience of skin and soft-tissue defects reparation with adjacent flap in face and head after resection of malignant tumor. Methods In 8 patents, there were 5 cases of basal cell epithelioma, 3 cases of cutanous squamous cancer. The lesion was excited with 5-15mm margin respectively, Secondary defects were repaired with local skin flap, the length of flap was 1-3 times as long as the width and the areas were 10-30% percent larger than recipient site. Soft tissue flaps were elevated from superficial layer of SMAS in face and formed between epicranial aponeurosis and periosteum in head. According to the shape, position of the defects the hatchet flap, transposition skin flap, modified rhomboid flap, nasolabial sulcus flap and bipedicled advance skin flap were used respectively. Results After operation, all flaps survived with primary healing, the flap donor sites were sutured in one stage except in 1 cases that the split free grafting skin had to be used due to tissue defect was bulky. The aesthetic and functional results were satisfactory and no one relapsed after 3 -8 months following-up. Conclusion The elevating of adjacent random flap is easy and it is abundant in blood supply. It is a particularly ideal method for the facial skin defects repair which can not be sutured directly.