局部皮下筋膜蒂V-Y皮瓣在面部皮肤缺损修复的临床应用

Reconstruction of facial skin defects by the V-Y subcutaneous pedicle flap

目的探讨局部皮下筋膜蒂V-Y皮瓣在面部皮肤缺损修复中的应用和效果。方法回顾性分析2012年3月—2021年4月广东省中西医结合医院耳鼻喉科收治并行面部V-Y皮瓣修复的患者23例,其中男性14例,女性9例,年龄45~85岁。病变部位包括面颊部12例(4例涉及下睑),鼻部4例,唇部3例,颞部2例,颏部2例。病理诊断包括基底细胞癌7例,鳞状细胞癌2例,恶性黑色素瘤1例,皮肤角化病7例,皮内痣3例,毛母质瘤1例,混合瘤1例,表皮囊肿1例。根据缺损部位设计合适的皮下筋膜蒂V-Y皮瓣进行修复。总结该皮瓣的血供优势、成活率及不良事件的发生情况;应用χ^(2)检验对不同类型患者的观察结果进行统计学分析。结果23例均经手术切除原发病灶,术中冷冻病检尽量取得切缘阴性,本组有1例多次切除后仍有1个切缘阳性。缺损面积14 mm×12 mm~59 mm×54 mm。全组皮瓣均成活。本组出现的不良事件是“Y”形三臂会合处及附近表皮少部分坏死结痂共4例,经湿敷、换药后脱痂愈合;其余患者创面一期愈合。不良事件的发生率上根据皮瓣的双蒂与单蒂(4/19比0/4)、良性病变与恶性病变(4/13比0/10)以及患者有基础病与无基础病(1/6比3/17)进行比较差异均无统计学意义(χ^(2)值分别为0.98、3.56、0.01,P值均>0.05)。全组无裂开、血肿、睑外翻、唇部变形等并发症。良性患者随访3个月以上;恶性肿瘤患者随访6~36个月,无复发。结论对于面部中小型缺损的修复,如处理恰当,V-Y皮下筋膜蒂皮瓣有可能成为“不易坏死”的局部皮瓣。

Objective To investigate the method and efficacy of reconstruction of facial skin defects after removing the lesions by applying the V-Y subcutaneous pedicle flap.Methods A retrospective analysis was performed on 23 patients with facial reconstruction by using V-Y subcutaneous pedicle flap in the Otolaryngology Department of Guangdong Integrated Traditional Chinese and Western Medicine Hospital from March 2012 to April 2021.Patient ages ranged from 45 to 85 years old,with a mean age of 66.5 years(14 males and 9 females).The facial lesion sites included cheek in 12 cases(nearly lower eyelid in 4 cases),nose in 4 cases,lips in 3 cases,temporal in 2 cases and mental region in 2 cases.The initial pathology included malignant tumors(7 cases of basal cell carcinoma(BCC),2 cases of squamous cell carcinoma(SCC),and 1 case of malignant melanoma)and benign lesions(7 cases of keratoderma,3 cases of intradermal nevus,1 case of pilomatricoma,1 case of cutaneous mixed tumor and 1 case of epidermal cyst).The V-Y subcutaneous facial pedicled flaps were designed reasonably after the facial lesions were excised.The advantages of blood supply,survival rate and adverse events of the flap were analyzed Chi-square test was used to compare the observation results of different types of patients.Results The primary focus of 23 patients was excised surgically,and intraoperative frozen-section examinations were performed for obtaining margins negative as far as possible.One positive margin was still found in 1 patient after multiple resection in our group.The defect sizes were 14 mm×12 mm-59 mm×54 mm.All the flaps survived.The adverse events were slight necrosis of the epidermis at the junction or vicinity of the three arms of"Y"shaped in 4 cases,but the wounds finally recovered by wet compress and dressing change.There were no significant differences in the incidences of adverse events between double and single pedicle flaps(4/19 vs.0/4),between benign and malignant lesions(4/13 vs.0/10),and between patients with and without underlying diseases(1/6 vs.3/17)(χ^(2) values were 0.98,3.56,0.01,respectively,all P>0.05).There were no other major complications such as dehiscence,hematoma,eyelid ectropion and lip deformation.The patients with benign lesions were followed-up at least for 3 months,while those with malignant tumors were followed-up for 6-36 months postoperatively,without recurrence.Conclusions V-Y subcutaneous facial pedicled skin flap may be a"no-easy-necrotic"local flap in the repair of small and medium-sized facial defects.