穿支皮瓣在面部恶性肿瘤切除术后创面美容性修复中的应用

Application of perforator flaps in cosmetic repair after facial malignant tumor resection

目的探讨穿支皮瓣在面部恶性肿瘤切除术后创面美容性修复中的临床应用价值。方法回顾性描述性研究。纳入2016年2月—2021年2月在成都医学院第二附属医院、溧阳市人民医院整形外科面部恶性肿瘤切除术后面部缺损患者50例,其中男20例、女30例,年龄38~95岁。肿瘤切除后,面部皮肤缺损1.5 cm×1.5 cm~3.5 cm×7.5 cm。根据患者恶性肿瘤切除术后面部缺损的大小、位置与形状,设计推进、旋转、螺旋桨等多种面部穿支皮瓣进行创面修复。皮瓣面积1.5 cm×1.0 cm~ 12.0 cm×6.0 cm;蒂部穿支血管直径在0.3~3.0 mm,其中2例蒂部为穿支血管束。术后观察皮瓣存活情况,同时对并发症予以对症处理;术后对皮瓣色泽、修复后功能、美观度及复发情况进行随访,评价其创面修复效果。结果本组50例手术均顺利完成。术后49例皮瓣一期愈合;1例术后皮瓣淤血,予针刺放血、局部按摩治疗,1周后好转,伤口延迟愈合。供区切口均一期愈合。术后随访3 ~24个月,皮瓣的质地、颜色和触感与周围皮肤相一致,供区瘢痕不明显,50例患者对术后皮瓣供区与受区功能及外形均满意。结论采用穿支皮瓣对面部恶性肿瘤切除后面部缺损进行修复,是一种安全、可靠的修复方式,对面部恶性肿瘤切除术后创面的美容性修复具有一定的临床价值。

Objective This study aimed to investigate the clinical application of perforator flaps in cosmetic repair after facial malignant tumor resection.Methods The retrospective and descriptive method was conducted.From February 2016 to February 2021,we treated 50 patients(20 males and 30 females,aged from 38 years to 95 years)with facial malignant tumor defects in the Department of Plastic and Burn Surgery of the Second Affiliated Hospital of Chengdu Medical College and the Liyang People's Hospital.After tumor resection,the areas of the facial skin defects ranged from 1.5 cm×1.5 cm to 3.5 cm×7.5 cm.The wounds were repaired by using a variety of facial perforator flap methods,such as propulsion,rotation,and propeller,in accordance with the sizes,positions,and shapes of the facial defects after the resection of the malignant tumors.The flap resections ranged from 1.5 cm×1.0 cm to 12.0 cm×6.0 cm.The diameters of the pedicle perforating vessels ranged from 0.3 mm to 3.0 mm,and in two cases,the peduncular perforator was the vascular bundle.Flap survivability was observed in terms of time after operation,and treatment was adopted in accordance with the symptoms that appeared.Flap color,function,aesthetics,and recurrence were followed up,and the wound repair effect was evaluated.Results The operation of all 50 cases in this group was successfully conducted.After operation,the wounds of 49 cases healed in the first stage,and one case of skin flap suffered from postoperative congestion and bleeding but improved after 1 week through acupuncture and local massage,and delayed wound healing.All incisions in the donor area healed in the first stage.All patients were followed-up for 3-24 months after surgery.The texture,color,and sensation of the flap were consistent with those of the surrounding skin,and donor scarring was not obvious.All 50 patients were satisfied with the donor and recipient function and appearance of the flap after surgery.Conclusions The use of perforator flaps to repair facial defects after the resection of facial malignant tumors is a safe and reliable method that has important clinical significance for the cosmetic repair of wounds after the resection of malignant tumors.