基于分区及血供设计风筝皮瓣修复鼻部皮肤癌术后缺损的效果

Kite subcutaneous pedicle flap design in postoperative defect repair of nasal skin cancer based on partition and blood supply

目的:探讨根据分区及血供设计风筝皮下蒂皮瓣修复鼻区皮肤癌术后缺损的临床效果。方法:2018年3月至2020年9月,郑州大学第一附属医院整形外科用风筝皮下蒂皮瓣修复鼻部皮肤癌(基底细胞癌、Bowen病、鳞状细胞癌、恶性黑素瘤)患者39例,男25例,女14例;年龄36~92岁,平均56岁。结果:39例患者均接受鼻部鼻旁风筝皮瓣手术治疗,共计44例皮瓣,皮瓣供区来源分别为鼻尖区4例,双侧鼻翼7例,双侧鼻唇沟区19例,双侧鼻旁12例及眉间区2例。术后无皮瓣坏死、血肿或感染等严重并发症。随访6~24个月,2例患者诉术区偶有刺痛,1例患者诉偶有瘙痒感,1例鳞状细胞癌患者局部复发再次接受手术。术后6个月对术区瘢痕进行评估,温哥华瘢痕量表及视觉模拟量表评分分别为(2.42±1.04)和(7.83±1.21)分。术区皮肤颜色与周围皮肤相近,无明显局部牵拉变形。结论:考虑分区及血供设计风筝皮下蒂皮瓣,皮瓣成活率高,并发症少,局部外观变形小,值得推广应用。

Objective To investigate the clinical effect of repairing postoperative nasal skin cancer defect with subcutaneous pedicle flap based on partition and blood supply.Methods From March 2018 to September 2020,39 patients with skin cancer(basal cell carcinoma,Bowen′s disease,squamous cell carcinoma and malignant melanoma in situ)were repaired with kites subcutaneous pedicle flap after extensive resection.Results Thirty-nine patients were treated with parafasal kite flaps,including 44 cases.The donor sites of the flap were nasal tip in 4 cases,bilateral alar in 7 cases,bilateral nasolabial sulcus in 19 cases,bilateral parasinal in 12 cases and interglabellar in 2 cases.There were no serious complications such as necrosis,hematoma or infection.During the follow-up period of 6 to 24 months,2 patients complained of occasional tingling in the surgical area,1 complained of occasional pruritus,and 1 patient had local recurrence of squamous cell carcinoma and underwent surgery again.The scar was evaluated 6 months after surgery,and the scores of Vancouver scar scale and visual analogue scale were 2.42±1.04 and 7.83±1.21,respectively.The skin color of the operation area was similar to that of the surrounding skin without obvious local strain deformation.Conclusions The subcutaneous pedicle flap designed by considering the nasal division and blood supply has a high survival rate,fewer complications and small local appearance deformation,which is worthy of popularization and application.