耳背带软骨膜皮片移植修复面部黑痣切除后缺损创面

EFFECTIVENESS OF PERICHONDRIAL CUTANEOUS GRAFT OF DORSAL AURICLE FOR REPAIRING FACIAL MELANOCYTIC NEVUS EXCISION DEFECT

目的探讨耳背带软骨膜皮片(perichondrial cutaneous graft,PCCG)移植修复面部黑痣切除后缺损的效果,并比较不同部位的疗效差异。方法 2008年2月-2012年10月,收治29例面部不同部位黑痣患者。男11例,女18例;年龄3~25岁,中位年龄11岁。其中上睑黑痣5例,鼻部黑痣15例,面颊部黑痣9例。黑痣范围1.2 cm×1.0 cm^4.0 cm×2.2 cm。黑痣切除后采用PCCG移植修复创面,移植皮片范围为1.5 cm×1.5 cm^4.2 cm×2.5 cm。随访时患者对受区局部颜色、瘢痕增生、平整度的满意程度进行评分,比较不同部位治疗效果。结果术后耳背PCCG全部成活。患者均获随访,随访时间7~15个月,平均10个月。29例PCCG移植至受区后颜色匹配好,无明显色素沉着,瘢痕增生轻微,其中鼻部皮片平整度良好,眼睑皮片平整度稍差。疗效满意度评分比较显示,在颜色方面3个部位间差异无统计学意义(P>0.05);在瘢痕增生方面,鼻部评分显著高于面颊部和上睑(P<0.05),面颊部和上睑间差异无统计学意义(P>0.05);在平整度方面,面颊部和鼻部评分显著高于上睑(P<0.05),面颊部与鼻部间差异无统计学意义(P>0.05)。总体评分:面颊部和鼻部评分显著高于上睑(P<0.05),鼻部评分也高于面颊部(P<0.05)。结论耳背PCCG移植修复面部黑痣切除后缺损具有与受区良好的颜色匹配,在修复鼻部黑痣切除后缺损时瘢痕增生和平整度方面也令人满意。

Objective To investigate and compare the effectiveness ofperichondrial cutaneous graft （PCCG） of dorsal auricle for repairing defect after excision of melanocytic nevus in different parts of the face. Methods Between February 2008 and October 2012, 29 cases of facial melanocytic nevus were admitted. There were 11 males and 18 females, aged 3-25 years （median, 11 years）. The locations were the upper eyelid in 5 cases, the nose in 15 cases, and the buccal region in 9 cases. The size of the nevi ranged from 1.2 cm x 1.0 cm to 4.0 cm x 2.2 cm. Defects after excision of nevi were repaired by PCCG of the dorsal auricle, which size ranged from 1.5 cm x 1.5 cm to 4.2 cm x 2.5 cm. The postoperative effectiveness was scored by patients according to color match, scar formation, and flatness of the reception site. The satisfaction evaluations were compared by the score among different parts. Results All the PCCG survived. All the patients were followed up 7-15 months （mean, 10 months）. All the reception site had good color match and acceptable scar formation. The nasal part had good flatness, and the upper eyelid had poor flatness. Score comparison showed no significant difference in color match between 3 parts （P 〉 0.05）. Nasal part had significantly less scar formation than buccal region and upper eyelid （P 〈 0.05）, but no significant difference between buccal region and upper eyelid （P 〉 0.05）. Nasal part and buccal region both had significantly better flatness than upper eyelid （P 〈 0.05）, but no significant difference between nasal part and buccal region （P 〉 0.05）. The overall evaluation score of nasal part and buccal region was significantly higher than that of the upper eyelid group （P 〈 0.05）, and the score of the nasal part was significantly higher than that of the buccal region （P 〈 0.05）. Conclusion PCCG of dorsal auricle has a good color match in repair of facial defect, especially in repair of nasal defect with good flatness and no obvious scar formation.