拇展肌肌皮瓣修复足跟恶性黑色素瘤软组织缺损的临床应用

Clinical application of abductor hallucis flap in restoration of soft tissue defects in calcar pedis melanoma

目的探讨拇展肌肌皮瓣修复足跟恶性黑色素瘤软组织缺损的临床疗效。方法采用带血管神经蒂的拇展肌肌皮瓣修复足跟部恶性黑色素瘤广泛切除术的软组织缺损18例,其中伴有溃疡出血者7例。皮肤缺损面积(2～6)cm×(5～9)cm,肌皮瓣切取面积(4～8)cm×(7～11)cm,深层拇展肌肌肉面积3cm×7cm,供区均采用中厚皮片游离植皮,并进行随访。结果术后18例肌皮瓣完全存活,创面Ⅰ期愈合;随访时间7～36个月,平均25个月,局部无复发;肌皮瓣质地优良,外观满意,未出现行走异常,皮肤感觉恢复良好。结论拇展肌肌皮瓣血液供应可靠,转移方便,是修复足跟部位恶性黑色素瘤广泛切除软组织缺损的良好选择。

Objective To evaluate the clinical application of the abductor hallucis flap in restoration of the soft-tissue defects in calcar pedis melanoma.Methods Eighteen cases of calcar pedis melanoma received abductor hallucis flap restoration with neurovascular pedicle for soft-tissue defects,among which,7 cases were complicated with ulcer and bleeding.The area of skin defect was（2 to 6） cm ×（5 to 9） cm,of myocutaneous flap was（4 to 8） cm ×（7 to 11） cm,and of muscular of abductor hallucis was 3 cm ×7 cm.Intermediate thickness free skin grafts were used in donor site.All cases were followed up.Results All musculocutaneous flaps survived after surgery in all cases,and the wound healed in stage Ⅰ.All cases were followed up for 7 to 36 months,with an average of 25 months,and no local recurrence occurred.The musculocutaneous flap maintained good quality with satisfactory appearance.All patients walked properly,and cutaneous sensation recovered well.Conclusion With reliable blood supply and being easy to transfer,the abductor hallucis flap is a good choice in restoration of soft tissue defects in calcar pedis melanoma.