局部联合皮瓣修复鼻部皮肤肿瘤切除后大面积缺损的效果

Application of combined local flaps in repair of large nasal defects after cutaneous tumor excision

目的探讨根据鼻亚单位修复重建技术,用局部联合皮瓣修复鼻部皮肤肿瘤切除后大面积皮肤缺损的经验。方法2007年5月至2019年5月,山东省济宁市第一人民医院整形美容科修复鼻部肿瘤切除后大面积缺损患者21例(男13例,女8例;年龄10~89岁,中位年龄62岁)。恶性肿瘤均采用术中冰冻病理检查,诊断病变性质及切缘阴性。肿瘤切除后致鼻缺损1.3 cm×0.9 cm至3.6 cm×3.1 cm。采用局部联合皮瓣修复皮肤缺损。供区创面直接拉拢缝合。结果21例患者供区均一期愈合。修复创面一期愈合20例;1例皮瓣远端少许表皮坏死,换药后愈合。术后21例随访1~48个月。鼻外形、通气功能良好,皮瓣色泽、质地与周围皮肤接近,恶性肿瘤无复发,供区瘢痕隐蔽,不明显。结论遵循鼻亚单位美学原则,依据创面及周边皮肤情况,用局部联合皮瓣修复鼻部肿瘤切除后大面积缺损,可获得满意效果。

Objective To explore the experience to reconstruct large nasal defects with combined local flaps after cutaneous tumor excision based on the aesthetic subunit principle.Methods From May 2007 to May 2019,based on the nasal aesthetic subunit principle,combined local flaps were used to cover the large nasal defects in 21 cases of nasal tumors that were removed.Among 21 cases,there were 11 cases of basal cell carcinoma,7 cases of squamous cell carcinoma,and 3 cases of pigmented naevus.The locations were dorsum of nose in 8 cases,nasal side in 7 cases,nasal ala in 5 cases,nasal tip in 1 case,and across two nasal subunits in 17 cases.The area of the defect ranged between 1.3 cm×0.9 cm and 3.6 cm×3.1 cm.A local combined skin flap was used to repair the skin defect.The secondary defect of donor site was directly sutured.Results Among 21 cases,20 cases acquired complete recovery;1 case had epiderm necrosis over the far end of the flap achieved healing by the first intention.The nasal defect was successfully repaired in all patients,and the all flaps survived.A total of 21 patients were available for follow-up of 1 to 48 months,no tumor recurrence occurred,and the repaired tissues were well matched to the surrounding tissue,good nasal contour was obtained,and the cosmetic results were satisfactory.Conclusions Based on the nasal aesthetic subunit principle,the combined local flaps can be used to reconstruct the large nasal defects,and the cosmetic results are satisfactory.