改良双叶瓣修复颧面部皮肤癌术后缺损的疗效

RECONSTRUCTION OF ZYGOMATIC-FACIAL MASSIVE DEFECT USING MODIFIED BILOBED FLAP AFTER RESECTION OF SKIN CANCER

目的探讨改良双叶瓣修复颧面部皮肤癌切除术后缺损的疗效。方法 2009年8月-2011年10月,收治颧面部皮肤癌患者15例。男12例,女3例;年龄52～78岁,平均64.1岁。病程1～14个月,平均4.6个月。基底细胞癌11例,鳞状细胞癌4例。术前1例肿瘤病灶合并感染,余患者皮肤均无破溃;肿瘤均累及皮肤层。TNM分期:T2N0M213例,T3N0M3患者2例。肿瘤病灶切除后遗留缺损范围为4.0 cm×2.5 cm～6.5 cm×4.0 cm。采用改良的耳前、耳后双叶瓣修复缺损,切取范围第1叶皮瓣4.0 cm×2.5 cm～6.5 cm×4.0 cm,第2叶皮瓣3.0 cm×2.0 cm～5.0 cm×3.0 cm。结果术后1例切口部分裂开,经换药后痊愈;余患者皮瓣均顺利成活,切口均Ⅰ期愈合。14例获随访,随访时间12～24个月,平均18.7个月。患者面部无明显不对称,眼睑闭合无影响,无面神经损伤表现。随访期间均无肿瘤复发。末次随访时患者满意度评分:不满意1例,可以接受1例,比较满意7例,非常满意5例。结论使用改良耳前、耳后双叶瓣修复颧面部皮肤癌术后缺损可获得较好效果,且并发症少。

Objective To investigate the clinical application of the modified bilobed flap in the reconstruction of zygomatic-facial massive defect after resection of skin cancer. Methods Between August 2009 and October 2011, 15 patients with skin cancer in the zygomatic-facial region underwent defect reconstruction using modified bilobed flaps after surgical removal. There were 12 males and 3 females, aged 52-78 years （mean, 64.1 years）. The disease duration was 1-14 months （mean, 4.6 months）. Among the patients, there were 11 cases of basal cell carcinoma and 4 cases of squamous cell carcinoma; 1 patient had infection and the others had no skin ulceration; and tumor involved the skin layer in all patients. According to TNM staging, 13 cases were rated as T2N0M2 and 2 cases as T3N0M3. The defect size ranged from 4.0 cm × 2.5 cm to 6.5 cm × 4.0 cm after cancer resection. The modified bilobed flaps consisting of pre-auricular flap and post-auricular flap was used to repair the defect after cancer resection. The size ranged from 4.0 cm × 2.5 cm to 6.5 cm × 4.0 cm of the first flap and from 3.0 cm × 2.0 cm to 5.0 cm × 3.0 cm of the second flap. Results Partial incision dehiscence occurred in 1 case, and was cured after dressing change; the flaps survived and incision healed primarily in the other cases. Fourteen patients were followed up 12-24 months （mean, 18.7 months）. No recurrence was found, and the patients had no obvious face asymmetry or skin scar with normal closure of eyelid and facial nerve function. At last follow-up, the results were very satisfactory in 5 cases, satisfactory in 7 cases, generally satisfactory in 1 case, and dissatisfactory in 1 case. Conclusion The pre- and post-auricular bilobed flaps could be used to reconstruct the massive defects in the zygomatic-facial region after resection of skin cancer.