体表恶性溃疡扩大切除后创面修复46例

Wound Repair of Cancerous Ulcer Expanded Excision on Body Surface: An Experience of 46 Cases

目的探讨体表恶性溃疡扩大切除后创面的修复效果。方法回顾性分析我院烧伤整形科2009年2月~2015年1月收治的体表恶性溃疡患者46例,恶性肿瘤大小约(1.8 cm×2.0 cm)^(20.0 cm×14.0 cm),形成溃疡面积约(1.7 cm×2.0 cm)^(16.0 cm×13.0 cm),病灶扩大切除后创面约(4.5 cm×5.0 cm)^(21.0 cm×17.0 cm),术中标本送冰冻病理活检以明确切除范围,缺损区采用直接缝合、游离植皮、改良皮瓣移植等方法修复。结果本组创面直接缝合11例,游离皮片移植14例,局部皮瓣修复12例,改良岛状皮瓣修复7例,皮瓣联合皮片修复2例。本组46例中创面一期愈合43例;1例头部基底细胞癌创面移植皮片约1/5坏死,再次植皮后痊愈;2例上肢瘢痕鳞状细胞癌创面经皮瓣修复后,皮瓣与瘢痕缝合处部分切口裂开,经换药后痊愈。随访6个月~5年,8例术后1~2年内出现局部肿瘤复发,其中5例同时发生远处转移,其余38例患者无复发及远处转移。结论采用游离植皮、改良皮瓣等多种方法修复体表恶性溃疡病灶扩大切除后创面,效果良好,复发率低。

Objective To explore the effect of wound repair after extensive excision of malignant ulcer of the body surface. Methods The clinical data of 46 cases with malignant ulcer on body surface admitted from February 2009 to January 2015 were retrospectively analyzed. The malignant tumor sized from 1. 8 cm × 2. 0 cm to 20. 0 cm × 14. 0 cm,the area of the ulcer ranged from 1. 7 cm × 2. 0 cm to 16. 0 cm × 13. 0 cm,and the wound was about 4. 5 cm × 5. 0 cm to 21. 0 cm × 17. 0 cm after extensive excision. Frozen biopsy was performed to identify the resection area,and direct suture,free skin and improved skin flap transplantation was applied to repair the defective area. Results The wound was repaired by direct suture in 11 cases,free skin graft in 14 cases,local skin flap in 12 cases,modified island flap graft in 7 cases,and skin flap combined with free skin graft in 2 cases. Of 46 cases,43 cases achieved primary wound healing. One case appeared necrosis of 1/5 skin graft and cured by skin re-grafting. 2 cases had partial incision dehiscence of skin flap and scar suture,and were healed finally after changing dressing. After 6 months to 5 years followup,8 cases were found local tumor recurrence within 1 to 2 years,of which 5 cases had distant metastasis,and the other 38 cases had no recurrence or distant metastasis. Conclusion For malignant tumor-induced cancerous ulcer on body surface,extensive local excision followed by free skin graft and modified skin flap transplantation can achieve satisfactory therapeutic effects with low recurrence rate.