头面部皮肤恶性肿瘤手术切除及组织缺损修复探讨

Reconstruction of the tissue defects after excision of skin malignancies in the head and face region

目的:探讨头面部皮肤恶性肿瘤手术切除和组织缺损修复的临床经验。方法:1991年1月～2006年1月共收治56例头面部皮肤恶性肿瘤患者,术后组织缺损根据患者情况分别采用原位缝合12例、皮片移植8例、局部皮瓣25例、邻位皮瓣9例和远位皮瓣2例修复。结果:本组56例,除1例皮瓣远端表皮坏死,经换药治疗伤口II期愈合外,其余皮瓣及植皮均成活,供区均I期愈合。38例患者获随访1～6年,1例复发;复发病例为植皮治疗的鳞状细胞癌患者于术后1年复发,经再次手术扩大切除后采用皮瓣移位修复,随访3年未再复发;随访患者均存活良好,外形及功能满意。结论:头面部皮肤恶性肿瘤早期诊断、彻底切除、及时修复、杜绝复发及取得良好的外观和功能效果是治疗的关键所在。修复方法根据患者具体情况和头面部美学单位或亚单位原理遵循由简至繁的原则,尽可能兼顾缺损区域外形和功能的恢复。

Objective To investigate the clinical experiences of reconstruction of the tissue defects after resection of skin cancers in the head and face region. Methods From January 1991 to January 2006, 56 patients with skin malignancies in the head and face region were treated with different surgical techniques. According to the characteristics of the patients, the tissue defects were repaired with primary closure in 12 cases, free skin grafting in 8 cases, local skin flap in 25 cases, ortho-position skin flap in 9 cases, and distant skin flap in 2 cases. Results Among 56 cases, 55 skin flaps and skin graftings survived and incision healed by first intention; 1 flap necrosed at the epidermis of the distal end and healed by secondary intention after dressing changes. All of the donor sites healed by first intention. 38 patients were followed up for 1 to 6 years. Among these cases with follow up, 1 case of squamous cell carcinoma with skin grafting occurred recurrence after 1 year respectively and was given radical resection and was reconstructed with skin flap again,the other cases occurred no recurrence. All of patients with follow up survived well. The functional and aesthetic results are satisfactory. Conclusion The skin malignancies in the head and face region should be diagnosised and treated as early as possible. Radical resection, resistance recurrence and simultaneous reconstruction with the satisfactory functional and aesthetic results are crucial for the reconstructive surgeon and are key points of surgical treatments. Based on the aesthetic unit or subunit principles in the head and face region and according to the characteristics of the patients, selection of the reconstructive method must comply with the algorithm from simple to complex. Achievement of the functional and aesthetic outcome should be considered, if possible.