自由设计穿支蒂螺旋桨皮瓣修复肩背部皮肤恶性肿瘤创面的疗效分析

Efficacy analysis of using free-style perforator pedicled propeller flap to repair the wound of skin malignant tumor on the shoulder and back

目的探讨肩背部自由设计穿支蒂螺旋桨皮瓣修复皮肤恶性肿瘤扩大切除后创面的可行性和临床效果。方法2017年12月至2019年6月,宁波市第一医院整形修复重建外科收治肩背部皮肤软组织肿瘤患者9例,男7例,女2例,年龄51~84岁,平均67.5岁。其中皮肤鳞状细胞癌4例,基底细胞癌3例,隆突纤维肉瘤1例,黑色素瘤1例。术前应用彩色多普勒超声探测并标记穿支血管备用。术中将皮肤肿瘤扩大切除,并常规行快速冰冻切片明确诊断,确保切缘和基底阴性。根据创面大小和形状设计并切取病灶缘的自由穿支蒂螺旋桨皮瓣进行修复,观察患者术后伤口愈合、肿瘤复发、皮瓣成活、皮瓣弹性及外观、创面瘢痕、肩关节活动等情况。结果9例患者完整切除肩背部肿瘤,创面面积3.0 cm×7.0 cm^8.0 cm×9.0 cm,切取的穿支蒂螺旋桨皮瓣面积为3.0 cm×10.0 cm^8.0 cm×12.0 cm,术后皮瓣全部成活,供区与受区创面一期愈合。4例供区直接关闭,5例在小桨辅助下关闭。术后随访5~20个月,肿瘤无复发,皮瓣质地良好,外形不臃肿,瘢痕不明显,肩关节活动无受限。结论肩背部血供来源广泛,皮肤穿支血管丰富,以此为基础设计自由穿支血管蒂螺旋桨皮瓣操作简单、切取方便,是修复肩背部皮肤恶性肿瘤扩大切除后创面的一种理想方法。

Objective To explore the feasibility and effect of using free-style perforator pedicled propeller flap to repair the wound after extended resection of skin malignant tumor on the shoulder and back.Methods From December 2017 to June 2019,9 patients(7 males and 2 females,aged from 51 to 84 years,with an average age of 67.5 years)with skin malignant tumor of the shoulder and back were treated in the Department of Plastic and Reconstructive Surgery of Ningbo First Hospital.The etiologies included squamous cell carcinoma(n=4),basal cell carcinoma(n=3),skin juga fibrosarcoma(n=1)and malignant melanoma(n=1).Color Doppler ultrasound was used to detect and mark the perforating vessels before operation.After extended resection was performed,intraoperative frozen section identified pathological diagnosis,while also ensured margin and base being tumor-free.The defect size ranged from 3.0 cm×7.0 cm to 8.0 cm×9.0 cm.According to the wound size and shape,the perforator pedicled propeller flap ranged from 3.0 cm×10.0 cm to 8.0 cm×12.0 cm was designed to repair the wound.The donor area was closed directly.Results All 9 flaps survived with primary wound healing in donor and recipient areas.Follow-up for 5-20 months showed no tumor recurrence and there was no obvious bulky and scar formation.The movement of left shoulder joint was smooth.Conclusions The blood supply of the shoulder and back is extensive,and the skin perforating vessels are abundant.Free-style perforator pedicled propeller flap on the shoulder and back is a simple technique.It is an ideal flap to repair the wound defect after extended resection of skin malignant tumor on the shoulder and back.