头面部皮肤恶性肿瘤手术切除及创面修复与重建的方法探讨

Reconstruction of the wound 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及创面修复和重建的临床经验。方法:对2006年9月～2011年3月共收治的38例头面部皮肤恶性肿瘤患者进行回顾性分析,术后创面根据患者情况分别采用人工脱细胞异体真皮(MATRIDERM)移植10例、原位缝合8例、皮片和人工脱细胞异体真皮(MATRIDERM)联合移植4例,皮片移植2例、局部皮瓣6例、邻位皮瓣5例进行修复和重建。结果:本组38例,除1例人工脱细胞异体真皮(MATRIDER)M移植创面边缘感染经换药治疗伤口II期愈合外,其余皮瓣和值皮均成活,供区和人工脱细胞异体真皮(MATRIDER)M移植创面均I期愈合。32例患者获随访1～3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2年复发,经再次手术扩大切除后采用皮瓣移位修复,随访1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修复和重建。

Objective To investigate the clinical experiences of reconstruction of the wound after resection of skin cancers in the head and face region.Methods From September 2006 to March 2011,38 cases of skin cancers in the head and face which were treated with different surgical techniques and retrospectively analyzed.According to the characteristics of the patients,Matriderm grafting in 10 cases,primary closure in 8 cases,free skin and matriderm grafting in 4 cases,free skin grafting in 2 cases,local skin flap in 6 cases,ortho-position skin flap in 5 cases.Results Among 38 cases,28 skin flaps and skin graftings survived.10 Matriderm graftings and incision healed by first intention.One wound which was repaired with matriderm infected at the edge and healed by secondary intention after dressing changes.32 patients were followed up for 1 to 3 years.Among these cases with foIlow up,One case of squamous cell carcinoma with skin grafting occurred recurrence after 2 years respectively and was given radical resection and was reconstructed with skin flap again,the other cases occurred no recurrence.Allof patients with foIlow 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.