足跟部皮肤恶性肿瘤切除术后皮肤缺损修复方式的临床分析

Clinical analysis on the repair methods of skin defect after resection of skin malignant tumor in heel

目的通过比较皮瓣修复术和游离皮片移植术在足跟皮肤恶性肿瘤切除后皮肤缺损修复的近远期疗效,探讨足跟皮肤恶性肿瘤切除术后皮肤缺损的外科修复方法。方法选取2013年7月至2018年11月间辽宁省肿瘤医院骨与软组织肿瘤外科收治的符合入选标准的30例足跟部皮肤恶性肿瘤的病例,均行手术切除治疗,术后皮肤缺损较大,不能直接缝合,根据手术切除后皮肤缺损修复的方式分成A组(皮瓣修复组)和B组(游离皮片移植组)。分别对A、B两组病例的一般资料以及术后短期植皮或皮瓣的成活情况,术后长期皮瓣或植皮皮肤的外观满意度、皮肤麻木感觉、分离不适感、生存转归、辅助治疗、肿瘤复发转移、关节功能活动度等治疗数据进行统计分析。结果A组和B组病例在不稳定感(关节活动障碍或组织分离感)、肿瘤复发转移、生存转归、辅助治疗(包括放疗、化疗、免疫治疗、生物治疗)等方面差异无统计学意义;在近期皮瓣或植皮成活率、患者外观满意度、皮肤麻木感觉及关节功能活动度这四方面差异有统计学意义(均P<0.05)。患者的主观评价在外观满意和皮肤麻木感方面以及客观关节功能活动方面,A组优于B组。结论皮瓣修复和游离皮片移植都可作为修复足跟皮肤恶性肿瘤切除术后皮肤缺损的修复方式,足跟部负重区皮肤缺损的修复应优先选择转移皮瓣。

Objective To explore the surgical repair methods of skin defects after resection of skin malignancies in heel by comparing short-term and long-term effects of skin flap repair and free skin graft transplantation.Methods From July 2013 to November 2018,30 cases of heel malignant skin tumors in the Department of Bone and Soft Tissue Tumor Surgery of Liaoning Cancer Hospital who underwent surgical resection without suture directly since the large area of defect were enrolled into this study.According to the way of skin defect repair after surgical resection,the patients were divided into A group(flap repair)and B group(free skin graft transplantation).Basic clinical data including pathological type of tumor,location of tumor,tumor size,operation choice and the survival of short-term and long-term after surgery were compared between the two groups.Statistical analysis was performed on treatment data including appearance satisfaction,skin numbness,discomfort of separation,outcome of life,adjuvant therapy,tumor recurrence,organ metastasis,and joint function activity.Results There was no significant difference in the sense of instability(joint dysfunction and tissue separation),tumor recurrence and metastasis,survival outcome,adjuvant treatments(radiotherapy,chemotherapy,radio chemotherapy and biology).There were significant differences in the survival of short term(P=0.035),patient satisfaction with appearance(P=0.038),skin numbness(P=0.045)between the two groups.The patients in group A had better activity of joint function compared with group B(P=0.018).Conclusions Both flap repair and free skin graft transplantation can be used to repair skin defects after resection of heel skin malignancies.Skin flaps in the heel-bearing area should be preferentially selected for repair.