窄蒂鼻唇沟皮下蒂皮瓣在鼻部及鼻旁恶性肿瘤切除后创面修复中的应用

Application of subcutaneous pedicle flap of narrow pedicle nasolabial fold in wound repair after resection of nasal and paranasal malignant tumors

目的探讨窄蒂鼻唇沟皮下蒂皮瓣在鼻部及鼻旁恶性肿瘤切除术后修复面部缺损的效果。方法回顾性队列研究。纳入蚌埠医学院第一附属医院整形外科2018年6月—2022年6月收治的鼻部及鼻旁体表恶性肿瘤患者40例,其中男13例、女27例,年龄52~93(69±12)岁。患者均行肿瘤扩大切除术,根据肿瘤切除后创面修复方法不同分为2组:对照组20例,采用传统的局部转位皮瓣修复;观察组20例,采用窄蒂鼻唇沟皮下蒂推进皮瓣修复。观察并比较2组患者的临床基线资料,皮瓣面积、皮瓣蒂部宽度、皮瓣面积与蒂部宽度比值、手术时间、术中出血量、皮瓣存活率、供瓣区直接缝合率等围术期指标,术后6个月温哥华瘢痕量表(VSS)评分,以及术后创面感染、皮瓣下积液、创面出血、皮瓣对周围组织牵拉、蒂部“猫耳”形成等并发症发生情况。结果2组患者年龄、性别、住院时间以及肿瘤性质、大小、部位等基线资料比较,差异均无统计学意义(P值均>0.05)。观察组皮瓣面积为(6.90±1.94)cm^(2),对照组为(7.80±2.24)cm^(2),差异无统计学意义(t=1.36,P=0.182)。观察组皮瓣蒂部宽度(0.98±0.29)cm、皮瓣面积与蒂宽比值7.35±2.75、手术时间(70.5±16.7)min、术中出血量(47.5±8.5)mL,对照组依次为(2.93±0.65)cm、2.75±0.82、(83.5±19.9)min、(60.5±15.0)mL,组间比较差异均有统计学意义(t=12.25、7.17、2.24、3.36,P值均<0.05)。观察组与对照组皮瓣存活率分别为95.0%(19/20)和90.0%(18/20),差异无统计学意义(χ^(2)=0.00,P=1.000)。观察组供瓣区直接缝合率为95.0%(19/20),高于对照组的60.0%(12/20),差异有统计学意义(χ^(2)=5.16,P=0.023)。术后6个月观察组血管循环VSS评分为(1.40±0.99)分,对照组为(1.65±0.81)分,差异无统计学意义(t=0.87,P=0.388);观察组皮瓣色泽、柔软度、厚度VSS评分及VSS总分分别为(0.90±0.64)、(2.00±1.03)、(1.30±0.92)、(5.60±3.27)分,对照组依次为(1.45±0.76)、(2.65±0.81)、(1.95±0.89)、(7.70±2.66)分,差异均有统计学意义(t=2.48、2.22、2.27、2.23,P值均<0.05)。观察组与对照组术后发生皮瓣对周围组织牵拉分别为7例和14例、蒂部猫耳形成分别为5例和16例,组间比较差异均有统计学意义(χ^(2)=4.91、12.13,P值均<0.05)。2组患者术后切口感染、出血、皮瓣下积液发生率比较,差异均无统计学意义(P值均>0.05)。结论采用窄蒂鼻唇沟皮下蒂皮瓣修复鼻部及鼻旁恶性肿瘤切除后的软组织缺损创面,对蒂部及供瓣区的处理优于传统的局部邻近皮瓣,且有效缩短手术时间、减少出血量、提高术后皮瓣美观度、减少并发症发生。

Objective This study aimed to investigate the application effect of subcutaneous pedicle flap of narrow pedicle nasolabial fold on the repair of facial defects after resection of nasal and paranasal malignant tumors.Methods A retrospective cohort study was conducted.From June 2018 to June 2022,40 patients were admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Bengbu Medical College for defect repair after resection of malignant tumors of the nasal and paranasal body surface.Among them,13 were males and 27 were females,aged 52-93(69±12)years.According to the different treatment methods,the subjects were divided into two groups:the control group involving 20 cases using traditional local flap repair,and the observation group involving 20 cases repaired by narrow pedicle nasolabial fold subcutaneous peduncular flap.The clinical baseline data of the two groups were observed and compared.These data included perioperative indicators such as flap area,flap peduncle width,ratio of flap area to peduncle width,operation time,intraoperative blood loss,flap survival rate,direct suture rate of donor valve,Vancouver scar scale(VSS)score,incision infection,subflap effusion,postoperative hemorrhage,stretching of surrounding tissues,and"cat ear"formation of pedic.Results No significant differences existed in the baseline data of age,sex,tumor nature,size,location and length of hospital stay between the two groups(all P values>0.05).The flap area was(6.90±1.94)cm^(2)in the observation group and(7.80±2.24)cm^(2)in the control group,and there was no significant difference between the two groups(t=1.36,P=0.182).The width of the flap pedicle was(0.98±0.29)cm,the ratio of flap area to pedicle width was 7.35±2.75,the operation time was(70.5±16.7)min,and the intraoperative blood loss was(47.5±8.5)mL in the observation group,and those were(2.93±0.65)cm,2.75±0.82,(83.5±19.9)min,and(60.5±15.0)mL in the control group,respectively,and the differences were statistically significant between the two groups(t=12.25,7.17,2.24,3.36;all P values<0.05).The survival rates of flaps in the observation and control groups were 95.0%(19/20)and 90.0%(18/20),respectively,and the difference was not statistically significant(χ^(2)=0.00,P=1.000).The direct suture rate of the donor valve area in the observation group(95.0%,19/20)was significantly higher than that in the control group(60.0%,12/20),and the difference was statistically significant(χ^(2)=5.16,P=0.023).The VSS score of vascular circulation in the observation group was(1.40±0.99)and(1.65±0.81)in the control group,and the difference was not statistically significant(t=0.87,P=0.388).The color,softness,thickness scores,and VSS scores in the observation group were(0.90±0.64),(2.00±1.03),(1.30±0.92),and(5.60±3.27)scores,respectively,which were lower than those in the control group(1.45±0.76),(2.65±0.81),(1.95±0.89),and(7.70±2.66)scores,respectively,and the differences were statistically significant(t=2.48,2.22,2.27,2.23;all P values were<0.05).There were 7 cases and 14 cases of postoperative flap traction between the observation group and the control group,and 5 and 16 cases of cat ear formation in the posterior pedicle,respectively,and the differences between the groups were statistically significant(χ^(2)=4.91,12.13;all P values<0.05).There was no significant difference in the incidence of postoperative incision infection,bleeding and subcutaneous fluid accumulation between the two groups(all P values>0.05).Conclusion Treatment of peduncle and donor flap is better than the traditional local adjacent-flap translocation repair of the soft-tissue defect wound of nasal and paranasal malignant tumors by using the subcutaneous pedicle flap of the narrow pedicle nasolabial fold.Treatment of peduncle and donor flap can effectively shorten the operation time,reduce the amount of bleeding,improve the aesthetics of the postoperative flap,and reduce the occurrence of complications.