足跟黑色素瘤扩大切除术后皮肤缺损的修复

Reparation of heel with malignant melanoma after extended resection

目的:探讨足跟黑色素瘤的扩大切除术后皮肤缺损的修复重建。方法:观察收治的足跟黑色素瘤9例,其中男5例,女4例。行扩大切除术,并根据足跟皮肤的缺损大小,分别选用带血管神经蒂的足外侧皮瓣、足底内侧岛状皮瓣和腓肠神经营养血管逆行皮瓣移位修复皮肤缺损区,手术前后均应用干扰素治疗。结果:9例患者皮瓣全部成活,随访3个月～5年,1例患者因黑色素瘤全身转移死亡,其余8例患者足跟部皮瓣形态、感觉、色泽、耐磨性、痛觉及功能均满意。其中足底内侧岛状皮瓣修复在功能方面最佳。结论:足跟部的恶性黑色素瘤采用扩大切除术,在切缘阴性的基础上进行修复重建,根据创面大小分别选用带血管神经蒂的足外侧皮瓣、足底内侧岛状皮瓣和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 reparation of heel with malignant melanoma after extended resection.Method Nine patients with malignant melanoma were treated,including 5 males and 4 females.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 9 cases.The postoperative follow-up was conducted from 3 months to 5 years.One patient died because of the transferring of malignant melanoma,but the flap shape,feeling,color,abradability,algaesthesis and function were good.The best result was acquired with plantar medial artery island skin flap.Conclusion Local extended resection is essential for the malignant melanoma of the heel.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 vessl.