头面部非黑色素瘤皮肤癌一期切除术后局部皮瓣修复预后分析

The prognosis analysis of head facial non melanoma skin cancer after resection of the first phase of local flaps to repair

目的：探讨头面部非黑色素瘤皮肤癌扩大切除术后缺损部位的不同修复方法及效果。方法收集2002年1月-2012年12月新疆医科大学附属肿瘤医院乳腺头颈肿瘤外科收治的176例头面部皮肤癌患者的资料，根据病灶的部位和范围，行扩大切除后分别采取游离创缘后拉拢缝合（41例，拉拢缝合组）、局部皮瓣转移修复（81例，局部皮瓣组）及皮片移植（54例，皮片移植组）行一期修复缺损，比较3组术后修复效果。结果拉拢缝合组5例切口裂开，睑外翻1例；皮片移植组9例缺血感染，植皮失败后重新植皮；局部皮瓣组仅1例出现皮瓣远端缺血坏死，余全部一期成活。局部皮瓣组愈合情况优于皮片移植组及拉拢缝合组。局部皮瓣组及皮片移植组满意度优于拉拢缝合组，而局部皮瓣组与皮片移植组满意度差异无统计学意义。随访1个月～10 a，3组患者均无肿瘤复发及转移。结论应根据头面部非黑色素瘤皮肤癌术后缺损的不同情况采用不同手术方法，拉拢缝合仅适用于病灶较小、局部皮肤松弛患者，对于修复较大皮肤缺损，局部皮瓣优于皮片移植及拉拢缝合。

Objective To investigate different repairing methods and effects of head facial defect parts after excision of dermoid cancer on the head and face.Methods 176 cases of head and facial skin cancer from 2002 January to 2012 December were collected.According to the location and extent of lesion,after enlar-ging resection 41 cases were taken free margin after suture;81 cases local skin flap adjuvant therapy;54 cases skin graft for a period repairing the defect of cutting range;then To compare the effect of postopera-tive rehabilitation.Results Three groups of postoperative adverse situation were compared,5 cases are in-cision suture dehiscence,1 cases case is eyelid ectropion;and 9 cases of ischemic infectionare skin graft failure;local flap necrosis occurred in 1 cases,all the rest of the issue of survival.skin flap and skin group satisfaction better than bringing in suturegroup,and skin falp and skin group no difference.The one month to 10 year follow-up without recurrence and metastasis.Conclusion According to the different situation of repairing the defect of head and face different methods,the repair of scalp and facial defects are larger rate to belocal skin flap skin grafting.