下颌缘皮瓣修复中老年面部恶性肿瘤术后缺损

Reconstruction of large facial defects via excision of skin cancer by using mandibular flap

目的探讨应用下颌缘皮瓣一期修复面部颧区、颊区、腮腺咬肌区皮肤软组织较大范围缺损的临床效果.方法2016年6月至2018年6月台州市第一人民医院整形美容科收治面部皮肤恶性肿瘤13例,男5例,女8例,年龄61~93岁.病变部位:颧区3例、颊区2例、腮腺咬肌区6例、复合区2例.病理诊断:鳞状细胞癌8例,基底细胞癌4例,纤维肉瘤1例.按Mohs法(术中送冰冻切片控制切缘)切除.根据缺损部位及范围,灵活应用同侧下颌缘皮瓣一期修复面部皮肤、软组织较大范围缺损,若为颧区非邻近部位的缺损,可采取下颌缘皮瓣、邻近皮瓣交叉修复.结果13例下颌缘皮瓣均顺利成活.经6~24个月随访,13例均获得满意的功能和外观,无明显眼部、鼻部、口唇畸形等并发症的发生.无一例肿瘤复发.结论灵活应用下颌缘皮瓣可修复面部颧区、颊区、腮腺咬肌区较大范围皮肤软组织缺损,是修复中老年面部皮肤恶性肿瘤手术切除后组织缺损的理想方法之一.

Objective To explore the effect of the mandibular flap application on one-stage repairing facial large defects after resection of skin tumors. Methods Thirteen patients with malignant facial skin tumors were treated from June 2016 to June 2018 in Taizhou First Hospital department of Plastic Surgery. The lesion included zygomatic in 3 cases (including 2 cases of non-adjacent defects in zygomatic area), buccal area area in 2 cases, parotid masseter in 6 cases and compound area in 2 cases. Pathological findings included 8 cases of squamous cell carcinoma, 4 cases of basal cell carcinoma and 1 case of fibrosarcoma. Using Mohs method resect the skin tumor (Rapid pathology intraoperatively to ensure lesion was all removed ). According to the diameter and location of the defect, the mandibular Flap was used to repair the large scale defects in a one-stage operation. Results All mandibular Flap survived. During a follow-up period from 6 to 24 months, all patients obtained excellent functional and aesthetic result, and none had local recurrence. Conclusions The flexible application of mandibular Flap can basically solve the problem of repairing a large area of facial skin and soft tissue defect in zygomatic, buccal and parotid masseter of the face, which is one of the ideal methods to repair the tissue defects after resection of facial malignant tumor for the middle and old age.