Pacman皮瓣在眼睑及周围皮肤软组织缺损修复中的应用

Repair of eyelid and periocular soft tissue defects with Pacman flap

目的探讨Pacman皮瓣修复眼睑及周围皮肤软组织缺损的临床效果。方法 2015年4月—2020年9月,收治12例眼睑及周围皮肤软组织缺损患者。其中男5例,女7例;年龄18~87岁,中位年龄63岁。病程6个月~50年,中位病程3年。缺损位于眼睑外侧5例,眼睑下方3例,眼睑下内侧2例,眼睑下外侧1例,眉外侧1例。病理诊断:皮肤基底细胞癌4例,皮肤鳞状细胞癌4例,皮肤交界痣1例,皮肤皮内痣1例,脂溢性角化症1例,皮肤角化棘皮瘤1例。术中切除肿物后软组织缺损范围为1.4 cm×1.2 cm~5.5 cm×5.0 cm。根据缺损周围皮肤的弹性和移动性,设计范围为1.6 cm×1.4 cm~10.0 cm×6.0 cm的Pacman皮瓣推进修复缺损。结果术后皮瓣全部成活,未发生坏死。术后1例患者发生切口感染,1例切口部分裂开,均经换药后愈合;其余患者切口均Ⅰ期愈合。12例患者均获随访,随访时间4~51个月,中位时间12个月。随访期间未见肿瘤复发转移;切口瘢痕不明显,眉毛、眼睑形态自然,无明显移位,患者对眼部形态和功能均满意。结论 Pacman皮瓣是一种简便易行、效果满意的眼睑及周围皮肤软组织缺损修复方法。

Objective To explore the effectiveness and safety of Pacman flap for repair of eyelid and periocular soft tissue defects. Methods The clinical data of 12 patients who underwent repair of eyelid and periocular soft tissue defects with Pacman flap between April 2015 and September 2020 was retrospectively reviewed. There were 5 males and7 females, aged from 18 to 87 years, with a median age of 63 years. The disease duration ranged from 6 months to 50 years,with a median time of 3 years. The defect was located on the lateral eyelid in 5 cases, inferior eyelid in 3 cases, inferior and medial eyelid in 2 cases, inferior and lateral eyelid in 2 cases, and lateral eyebrow in 1 case. Pathological diagnosis included4 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma, 1 case of junction nevus, 1 case of intradermal nevus,1 case of seborrheic keratosis, and 1 case of keratoacanthoma. The size of defects ranged from 1.4 cm×1.2 cm to5.5 cm×5.0 cm. According to the skin mobility and toughness around the defects, Pacman flaps with the size of 1.6 cm×1.4 cm to 10.0 cm×6.0 cm were designed and advanced to repair the defects. Results All flaps survived completely with no necrosis. One patient had infection, and another patient had partial wound dehiscence, but the wounds healed after dressing change without further debridement. Other patients all recovered successfully. The follow-up time ranged from4 to 51 months, with a median time of 12 months. No recurrence and metastasis occurred, and the scars were invisible without deformity of eyelid and brow. All patients were satisfied with the aesthetic and functional outcomes of the eyes.Conclusion Pacman flap is a simple and feasible technique for repair of eyelid and periocular soft tissue defects, with satisfactory effectiveness.