双叶皮瓣治疗包涵体纤维瘤病临床体会

Clinical application of bilobate skin flap in the treatment of inclusion body fibromatosis

目的:探讨包涵体纤维瘤病(inclusion body fibromatosis,IBF)足趾端病灶切除术后局部缺损创面的处理方法及其治疗策略。方法:回顾性分析2015年3月至2019年5月南京医科大学附属儿童医院烧伤整形科收治的11例足趾端IBF患儿的临床资料。其中,男8例,女3例;年龄4月龄至7岁9个月,平均25.3个月。11例患儿术中均于肉眼可见下完整切除足趾端坚硬如瘢痕样肿块,并于局部邻近皮肤设计双叶皮瓣覆盖手术局部皮肤缺损创面。结果:11例患儿术后局部创面均得到满意疗效。有2例术后出现切口渗出、皮瓣末梢少许坏死,积极干预后恢复良好顺利出院。所有患儿术后复诊未见明显组织功能受限及明显增生性瘢痕。最长随访时间为2年,有4例患儿出现复发,再次手术后均未再次出现复发。结论:对于足趾端IBF,建议早期手术切除并明确病灶性质;局部予以双叶皮瓣修复,以减少损伤,保存局部功能及外形;术后患儿需长期随访以防复发。

Objective To explore the treatments of local defect wound after removing inclusion body fibromatosis(IBF).Methods Retrospective review was performed for clinical data of 11 hospitalized IBF children from March 2015 to May 2019.There were 8 boys and 3 girls with an average age of 25.3(4-93)months.During operation,hard and scar-like mass was completely removed grossly and bilobate skin flap was designed for covering local skin defects.Results The postoperative results of 11 cases were satisfactory.Two cases of wound exudation and minimal necrosis of flap tip recovered well after active interventions and were discharged smoothly.No obvious tissue function limitation or obvious hyperplastic scar was evident.The longest follow-up time was 2 years.Four recurrent cases were re-operated with local flap repairing.There was no postoperative recurrence.Conclusions For IBF patients,early surgical resection is recommended and the nature of lesion should be confirmed.Bilobate skin flap is employed for repairing local skin defect to minimize tissue damage and preserve local function and appearance.Long-term follow-up is needed for preventing recurrence.