躯干部扩张皮瓣带蒂转移修复先天性上肢巨痣的临床研究

Pedicled Expanded Trunk Flap in the Treatment of Congenital Giant Nevus of Upper Extremity

目的探讨躯干部扩张皮瓣带蒂转移修复儿童先天性上肢巨痣的治疗效果。方法自2015年1月至2016年12月,采用躯干部扩张皮瓣带蒂转移治疗先天性上肢巨痣患儿7例。手术分3期进行:一期行躯干部扩张器置入术;二期行躯干部扩张器取出、上肢大面积病变组织切除、扩张皮瓣带蒂转移修复术;三期行皮瓣断蒂术。结果巨痣面积为16 cm×10 cm^30 cm×14.5 cm,均完全切除。术后随访6~39个月(平均25.5个月)。扩张皮瓣血运良好,颜色、质地与周围正常皮肤相近,无感染、血肿、皮瓣坏死、皮瓣挛缩等并发症。累及关节周围皮肤的病例,术后关节活动均正常。本组中有1例在注水过程中出现扩张器外露,但未影响皮瓣转移。结论躯干部扩张皮瓣带蒂转移可提供大面积正常皮肤,避免多次扩张,实用且治疗效果好,是修复上肢皮肤缺损的可靠方法。

Objective To explore the effect of pedicled expanded trunk flap in the treatment of congenital giant nevus of upper extremity in children.Methods From January 2015 to December 2016,7 cases of congenital giant nevus of upper extremity were treated with pedicled expanded trunk flap.The operation can be divided into 3 stages:Tissue expanders were implanted into the trunk in StageⅠ;After proper expansion,the giant nevus was resected and the expanded flap was transferred to the upper extremity to establish blood circulation in StageⅡ;Pedicle transection was performed in StageⅢ.Results The size of the nevus was 16 cm×10 cm to 30 cm×14.5 cm,all giant nevi were completely removed.All patients were followed up for 6 to 39 months(mean 25.5 months).All the flaps survived with good blood supply,the color and texture were similar to the surrounding normal skin,and there were no complications such as infection,hematoma,necrosis and contracture.For cases involving periarticular skin,postoperative joint movements were normal.Expander exposure was noted in 1 case,but had no negative effect on the result.Conclusion Pedicled expanded trunk flap can provide large areas of normal skin and avoid multiple expansions.It is practical and effective.It is a reliable method to repair the defect of upper extremity.