股前外侧岛状皮瓣联合自体中厚皮片游离移植治疗阴茎阴囊广泛Paget病切除后大面积皮肤破损的疗效分析

Use of anterolateral thigh flap and split-thickness skin grafting for soft tissve defectionof massive penoscrotal Paget＇s disease

目的 探讨应用股前外侧岛状皮瓣联合自体中厚皮片游离移植修复阴茎阴囊广泛Paget病切除后大面积皮肤缺损的疗效.方法 回顾性分析2005年2月至2010年10月收治的6例阴茎阴囊广泛Paget病患者的临床资料.年龄55～68岁,平均64岁 查体及B超、CT等辅助检查未发现其他恶性肿瘤存在,腹股沟未触及肿大淋巴结.患者均在硬膜外麻醉下接受扩大病灶切除术,切除范围超过病变边缘2 cm,用股前外侧岛状皮瓣重建阴囊,自体中厚皮片游离移植修复阴茎皮肤缺损.结果 本组6例手术修复创面150～210 cm2,平均185 cm2 .手术均顺利完成,手术时间210～300 min,平均270 min;术中出血量35～ 150 ml,平均75 ml.术后病理检查切缘均阴性.5例皮瓣及植皮成活良好,1例皮瓣远端出现部分表皮坏死,经二期清创植皮后创面愈合.重建阴囊、阴茎外观满意,随访10～ 60个月,平均37个月,未见复发 .结论 股前外侧岛状皮瓣联合自体中厚皮片游离移植治疗阴茎阴囊广泛Paget病切除后大面积皮肤缺损是一种切实有效的方法.

Objective To evaluate the effectiveness of using the anterolateral thigh flap and split- thickness skin grafting to repair large skin defect secondary to the exeision of massive penoserotal Paget＇s disease. Methods Clinical data of 6 patients with massive penoscrotal Paget＇s disease were retrospectively reviewed. The patients were admitted to our institute from Feb. 2005 to Oet. 2010 with mean age of 64 （55- 68） years. No other neoplasm and enlarged inguinal lymph node were detected on physical examination, ul- trasunography and CT scan. All eases underwent wide loeal excision of skin lesion which was taken 2 em be- yund the boundary under epidural anesthesia. An anterolateral thigh flap was used to reconstruct the scrotum, and the skin defeet of penis was repaired by split-thickness skin grafting. Results Operation was unevent- ful for the 6 patients, with mean skin defeet of 185 （150-210） cm2. The mean operative duration was 270 （210-300） rain, and the mean blood loss was 75 （35-150） ml. Negative surgical margins were confirmed on postoperative pathology. Five patients reeovered smoothly with satisfying cosmetic appearance, and one patient demonstrated partial neerosis of the flap which was repaired on secondary surgery. The mean follow-up was 37 （10-60） months, and no relapse was found. Conclusions It is an effeetive method to use antero- lateral thigh flap and split-thickness skin grafting to repair large skin defeet secondary to excision of massive penoserotal Paget＇s disease.