髂腹股沟皮瓣修复中下腹壁及腹股沟区隆突性皮肤纤维肉瘤切除术后缺损

Reconstruction of the middle and lower abdominal wall or the groin region defects following the resection of the dermatofibrosarcoma protuberan utilizing the ilioinguinal flap

目的总结应用髂腹股沟皮瓣修复中下腹壁、腹股沟区隆突性皮肤纤维肉瘤扩大切除术后缺损的方法及其效果。方法分析2011年11月—2018年10月中山大学孙逸仙纪念医院整形外科收治的9例腹股沟或中下腹壁隆突性皮肤纤维肉瘤患者资料,男5例,女4例,年龄27~60岁,平均44.3岁。肿物扩大切除术后缺损面积为9.5 cm×10.5 cm~15.0 cm×18.0 cm,髂腹股沟皮瓣大小为6.0 cm×11.0 cm~8.0 cm×15.0 cm,分别应用轴型皮瓣、V-Y推进皮瓣的方式修复缺损;9例患者中应用单侧髂腹股沟皮瓣5例,双侧髂腹股沟皮瓣联合皮瓣2例,髂腹股沟皮瓣联合阔筋膜张肌皮瓣1例,髂腹股沟皮瓣联合股前外侧皮瓣1例。术后观察皮瓣存活及缺损的修复情况,对肿瘤复发情况进行随访。结果全部移植的皮瓣均能覆盖全部受区创面,供区能直接缝合。除1例的髂腹股沟皮瓣远端小部分坏死予二期行清创及全厚皮片移植修复伤口外,其余移植的皮瓣均血运良好,伤口一期愈合。全部患者术后随访1.0~8.5年,均无肿瘤局部复发及远处转移,局部外形良好、感觉无异常。结论中下腹壁或腹股沟区的隆突性皮肤纤维肉瘤扩大切除术后缺损较大且深在,大部分病例均可应用单侧或双侧带蒂髂腹股沟皮瓣进行创面的修复,该皮瓣血运确切,手术操作简单、耗时少,安全可靠,术后外形满意,可获得良好的效果。

Objective To summarize the methods and effects of utilizing the ilioinguinal flap in repairing the defect after the extended resection of the middle and lower abdominal wall or the groin region’s dermatofibrosarcoma protuberans.Methods From November 2011 to October 2018,nine patients(including five males)with the middle and lower abdominal wall or groin region’s dermatofibrosarcoma protuberans received extended resection procedures in the Department of Plastic and Reconstructive Surgery of Sun Yat-sen Memorial Hospital,Sun Yat-sen University.The age distribution of patients was 27-60 years old with a mean age of 44.3 years old.The defect area following the extended resection of the tumor ranged from 9.5 cm×10.5 cm to 15.0 cm×18.0 cm,and the size of the ilioinguinal flap ranged from 6.0 cm×11.0 cm to 8.0 cm×15.0 cm.Either an axial flap or a V-Y advancement flap was used to repair the defect.Five patients were treated with the unilateral ilioinguinal flap,two with the bilateral ilioinguinal flap combination flap,one with the ilioinguinal flap combined with the tensor fascia lata myocutaneous flap,and one with the ilioinguinal flap combined with the anterolateral thigh flap.Results All defects were covered by flaps completely,and all donor sites were closed directly.Eight flaps survived completely without necrosis,while one case of ilioinguinal flap faced the distal necrosis,which was debrided and repaired with full-thickness skin grafting in the second stage.The postoperative follow-up period ranged from 1.0 to 8.5 years.No local recurrence or other distant metastases occurred.All reconstructed regions had a good outline and ordinary sense function.Conclusions Almost all defects after the extended resection of dermatofibrosarcoma protuberans in the middle and lower abdominal wall or the groin region could be repaired with a unilateral or bilateral ilioinguinal flap,whose blood supply is stable and reliable.Moreover,the operation presented is simple,less time-consuming,safe,reliable,and with a satisfactory postoperative appearance.