髂腹股沟皮瓣联合自体皮片移植修复阴茎阴囊广泛Paget病切除后皮肤缺损

Application of Ilioinguinal Skin Flap and Autologous Skin Grafting for the Repair of Penoscrotal Soft Tissue Defects After Surgical Treatment of Massive Paget’s Disease

目的探讨应用髂腹股沟皮瓣联合自体皮片游离移植修复阴茎、阴囊Paget病扩大切除后皮肤大面积缺损的效果。方法回顾性分析2011年1月~2021年1月20例广泛阴囊、阴茎Paget病患者的临床资料。年龄55~87岁,平均72岁;病程3个月~13年,中位数5年。未伴有其他恶性肿瘤,腹股沟无肿大淋巴结。均在全麻下行肿物扩大切除,沿病灶边缘外扩大3 cm切除病灶,根据快速冰冻切片结果扩大切除。病灶切除后缺损面积:阴囊150~210 cm^(2),平均182 cm^(2),阴茎及阴阜50~90 cm^(2),平均75 cm^(2)。根据皮肤缺损大小,采用髂腹股沟皮瓣修复阴囊皮肤缺损,采用自体全厚皮片修复阴茎皮肤缺损。结果20例术后皮瓣及皮片全部成活,其中15例获随访,随访3个月~5年,中位数12个月,其中<1年8例,1~3年5例,3~5年2例,重建阴囊及阴茎形态良好,未见肿瘤复发,患者对术后阴茎及阴囊外观满意。结论髂腹股沟皮瓣联合自体皮片移植修复阴茎、阴囊Paget病扩大切除后的大面积皮肤缺损,手术简单安全,重建阴茎阴囊形态满意,可以作为该病变病灶切除后覆盖创面的有效方法。

Objective To investigate the clinical effect of ilioinguinal skin flap and autologous skin grafting for the repair of penoscrotal soft tissue defects after enlarged surgical treatment of massive Paget’s disease.Methods Clinical data of 20 patients with massive penoscrotal Paget’s disease from January 2011 to January 2021 were analyzed retrospectively.The average age of all the patients were 72 years old(range,55-87 years old),and the median course of disease were 5 years(range,3 months-13 years).No other neoplasm or enlarged inguinal lymph nodes were detected on physical examination,ultrasonography and CT scanning.Under general anesthesia,the lesion was resected by enlarging 3 cm along the edge,and the wide local excision of skin was performed according to the results of rapid frozen section.The mean defect area after resection was 182(range,150-210)cm^(2) in scrotum and 75(range,50-90)cm^(2) in penis and caruncle.According to the size of skin defect,ilioinguinal skin flap was used to repair scrotal skin defect,and full-thickness skin grafting was used to repair penile skin defect.Results All the flaps and skin grafts survived in the 20 cases.A total of 15 cases were followed up for 3 months to 5 years(median,12 months),including 8 cases for less than 1 year,5 cases for 1 to 3 years,and 2 cases for 3 to 5 years.The shape of scrotum and penis was good and no tumor recurrence was found.The patient felt that the appearance of penis and scrotum was satisfactory after operation.Conclusions The ilioinguinal flap and autologous skin grafting can be used to repair penoscrotal soft tissue defects after enlarged surgical treatment of massive Paget’s disease.The method is effective and safe.The shape of penis and scrotum is satisfactory.It can be used as one of the effective methods to cover the wound secondary to excision of penoscrotal lesions.