多皮瓣联合修复乳房外Paget病切除后大面积缺损

Multiple flaps combined to repair large defects after resection of extramammary Paget disease

目的探讨阴茎阴囊局部皮瓣及邻位皮瓣联合修复乳房外Paget病(extramammary paget’s disease,EMPD)病变切除后大面积组织缺损的方法。方法自2012年1月至2021年12月,国家老年医学中心北京医院整形外科收治6例阴茎阴囊均有病变的患者,部分侵及阴茎阴囊外会阴组织,病变切除后缺损面积均>50%,评估缺损范围及阴茎阴囊残存覆盖组织,设计阴茎阴囊局部皮瓣及邻位皮瓣联合应用修复乳房外Paget病切除后大面积缺损。结果所有患者皮瓣均全部成活,无坏死,2例切口有少量渗出,换药后痊愈。随访12~61个月(平均33.6个月),其余5例未见复发。1例术后13个月复发,病变范围较小,直接切除,随访38个月未再复发。结论对于乳房外Paget病病变组织切除后大面积组织缺损,采用邻位皮瓣结合阴茎阴囊局部皮瓣修复,可以达到良好的修复效果,且保持阴茎阴囊正常功能和形态。

Objective To discuss the combination of penile scrotal flap and adjacent flap to repair large-scale tissue defects after resection of extramammary Paget disease.Methods All 6 patients with lesions in both penis and scrotum,some of which invaded the perineal tissue outside the penile scrotum,and the defect area after lesion resection exceeded 50%.The scope of the defect and the residual covered tissue of the penile scrotum were evaluated,and the combined application of local penile-scrotal flap and adjacent flap was designed to repair the defect.ResultsAll 6 cases of flaps survived,without flap necrosis,and 2 cases had a small amount of exudation from the incision,all of which were cured after dressing.Follow-up for 12 to 61 months(average 33.6 months),5 cases showed no recurrence,1 case relapsed 13 months after surgery,the lesion was small and directly resected,and there was no recurrence after 38 months of follow-up.Conclusion For the large area of tissue defect after resection of extramammary Paget disease,the adjacent skin flap combined with local penilescrotal flap to repair the penile scrotal area can achieve good repair effect and maintain the normal function and morphology of the penile scrotum.