局部随意皮瓣在外阴癌术后创面修复中的应用

The techniques of local random flap for vulval reconstruction after radical vulvectomy

目的探讨局部随意皮瓣转移修复术在外阴癌术后会阴区域创面修复的方法及疗效。方法回顾性分析2016年4月至2017年11月就诊于本院的12例外阴癌患者,外阴根治性局部扩大切除术中会阴部存在创面,无法直接关闭,应用局部随意皮瓣进行创面覆盖手术。结果 12例患者年龄55-78岁,中位年龄70岁,同期行腹股沟淋巴结切除术10例,外阴癌术后病理证实鳞癌11例,直肠腺癌转移癌1例。11例鳞癌患者肿瘤分期为：T2N0M0 3例,T2N1M0 5例,T2N2M0 2例,T3N1M0 1例。11例患者伤口均Ⅰ期愈合,1例出现局部伤口裂开,经换药治疗后延迟愈合,所有病例均未出现感染、出血、皮瓣坏死等并发症。12例患者随访时间2个月至20个月,中位时间6个月。截至2017年12月,各皮瓣恢复良好。结论对于外阴癌手术造成的会阴部创面,可以选择局部随意皮瓣手术进行创面修复及覆盖,该手术操作简单,安全有效,能够取得满意的疗效。

Objective To explore the techniques and short-term effectiveness of local random flap in reconstruction after radical vulvectomy. Methods Twelve patients with vulvar cancer received immediate local random flap reconstruction after radical local excision from April 2016 to November 2017. Results The patients were from 55 to 78 years old（median 70 years old）, and ten of them received immediate inguinal lymph node dissection. The tumors including 11 squamous cell carcinomas（7 high differentiated and 4 moderately differentiated）, and one metastatic carcinoma were confirmed by pathology examination.According to tumor TNM staging（11 SCC cases）, 3 cases were rated as T2N0M0, 5 cases as T2N1M0,2 cases as T2N2M0,and 1 case as T3N1M0. One patient had local poor wound healing postoperatively and was cured; primary healing was obtained in the other patients, and no other postoperative complication of infection, hemorrhage or flap necrosis was found. The patients were followed up 2 to 20 months（median 6 months）. There was no recurrence or metastasis. All flaps survived completely at the latest follow-up. Conclusion The local random flap for vulvar reconstruction after radical vulvectomy is an easy, safe, and reliable procedure.