狭长窄蒂皮瓣在面额部皮肤癌治疗中的应用

Application of slender narrow pedicle flap in facial skin cancer treatment

目的介绍一种打破常规任意皮瓣长宽比例限制的狭长窄蒂皮瓣在面额部皮肤癌切除后组织缺损修复中的应用，并探讨其成活机制。方法设计不带知名血管，以耳前或耳后狭长皮肤筋膜或单纯筋膜为蒂的侧颌颈部皮瓣，修复面额部皮肤癌切除后组织缺损26例，其中颞额区皮肤基底细胞癌5例，皮肤鳞状细胞癌6例，面部恶性黑色素瘤1例，基底细胞癌8例，鳞状细胞癌5例，皮肤黏液癌1例。26例皮瓣的蒂部有24例在耳前，2例在耳后；4例仅为筋膜蒂。皮瓣最大10．0cm×8．0cm，最小3．0cm×2．5cm，蒂宽1．0～1．5cm，蒂长2—6cm。结果26例狭长窄蒂皮瓣除5例皮瓣远端淤血，其后渐恢复，其余全部成活，修复后局部外形理想。结论该狭长窄蒂皮瓣不带知名血管，其长宽比例超过常规任意皮瓣，无需解剖血管，切取容易，蒂部狭长使其旋转和覆盖范围大，供、受区邻近，是修复面额部皮肤癌扩大切除后组织缺损的理想皮瓣。

Objective To Introduce the application of slender narrow pedicle flap in repairing facial tissue defects after skin carcinoma excision, and investigate its survival mechanism. Methods The slender narrow pedicle lateral maxillocevical flap was designed with its pediele including skin fascia or only the fascia located in front of auricle or behind of it, repaired 26 eases of facial defects, including 5 temporal skin basal cell carcinoma, 6 skin squamous cell carcinoma, and 1 facial skin malignant melanoma, 8 skin basal cell carcinoma, 5 skin squamous cell carcinoma, 1 skin mucinous carcinoma. In 26 cases, 24 cases their pedieles in front of the auricle, 2 cases behind of the auricle; 4 cases their pedicles only including fascia. The size of the flaps ranged from 3.0 cm × 2.5 cm to 10. 0 cm × 8.0 cm. The width and length of the pedicle ranged 1.0-1.5 cm and 2-6 cm. Results 26 cases of the slender narrow pedicle flaps all survived and the results were satisfactory except 5 cases of distal congestion, then gradual recovery. Conclusions This slender narrow flap don＇ t include any major blood vessel, without dissecting the blood vessels in operating. Due to its slender pedicle, the whole flap looks like ＂pingpang bat ＂, the flap rotation is easy and its coverage area is very large, without cat ears. The postoperative appearance （eolor,lexture, cosmetic aspect） is satisfactory. This slender narrow flap is an extraordinary new flap design and is ideal for the repair of the facial tissue defect after skin carcinoma excision.