游离腓肠内侧动脉穿支皮瓣修复足部鳞状细胞癌切除术后软组织缺损

Free perforator flap of medial sural artery in reconstruction of defect in foot after surgery of squamous cell carcinoma

目的:探讨以腓肠内侧动脉穿支血管为蒂的游离皮瓣移植修复足部鳞状细胞癌切除术后软组织缺损的临床疗效。方法:2017年6月至2019年12月,在广州市番禺区中医院手足显微创面修复外科就诊并诊断为足部高分化鳞状细胞癌的慢性创面患者7例,采用同侧肢体腓肠内侧动脉穿支皮瓣游离移植修复其肿瘤切除术后软组织缺损创面,其中男4例,女3例,年龄24~68岁,平均37岁。病灶切除术后创面大小为2.5 cm×5.5 cm~4.0 cm×8.0 cm,皮瓣切取面积3.0 cm×6.0 cm~4.5 cm×10.0 cm,7例皮瓣供区均直接缝合。术后对患者进行定期随访,随访内容包括皮瓣色泽及质地、皮瓣感觉的恢复、行走功能的恢复及供区愈合情况。结果:术后7例皮瓣全部成活,1例皮瓣术后出现边缘坏死,经积极换药治疗后,创面愈合。随访时间12~18个月,平均15.1个月。皮瓣质地柔软、富有弹性、不臃肿,足部承重功能良好,供区仅留线形瘢痕,腓肠肌收缩有力,行走时步态正常。皮瓣受区无渗液、窦道、慢性溃疡改变,癌变无复发及淋巴结转移。3例缝接皮神经的足部皮瓣恢复保护性感觉。结论:采用游离腓肠内侧动脉穿支皮瓣修复足部鳞状细胞癌切除术后软组织缺损创面,可以在同一术野完成手术操作,穿支血管解剖位置相对恒定,皮瓣切取相对简便,供区损伤小,是一种有效的修复方法。

Objective To investigate clinical effect of free perforator flap pedicled on medial sural artery in reconstruction of defect in left foot of squamous cell carcinoma surgery.Methods From June 2017 to December 2019,7 patients with chronic wounds in feet were diagnosed with highly differentiated squamous cell carcinoma of foot.The patients were treated at the Department of Microsurgical Wound Repair Surgery of Hand and Foot,Traditional Chinese Medicine Hospital of Panyu District in Guangzhou.Surgery were performed to remove the cancer and the defects in the feet caused by surgery were reconstructed with transfers of ipsilateral free perforator flaps pedicled on medial sural artery.The patients were 4 males and 3 females,aged 24-68 years old,with an average of 37 years old.Sizes of wound after resection of cancer was 2.5 cm×5.5 cm to 4.0 cm×8.0 cm.The flaps sized 3.0 cm×6.0 cm to 4.5 cm×10.0 cm.All the donor sites were directly sutured.Scheduled postoperative follow-ups were conducted.Investigation items included colour and texture of flap,flap sensation,walking condition and donor site healing.Results All 7 flaps survived after surgery.One patient had a marginal necrosis on flap after surgery,and the wound was healed after active dressing change.All patients had completed a 12-18 months follow-up,with 15.1 months in average.One patient had a marginal necrsis on flap after surgery,and the wound was healed after active dressing change.All flaps were soft in texture,in elastic and without bulky.All the feet had good load-bearing function.There were only linear scars in the donor sites without obvious dysfunction.All patients had normal gait.No infiltration,sinus or chronic ulcer was found in recipient sites,and there was no recurrence of cancer or lymph node metastasis.Three flaps with sutured cutaneous nerves showed protective senation.Conclusion The use of a free perforator flap pedicled on medial sural artery to reconstruct the soft tissue defect wound after tumer resection of squamous cell carcinoma in foot can be performed in same surgical field.Anatomical location of the perforator vessels is relatively constant and the flap is relatively easy to take.Damage to the donor site is minimum.It is one of the effective methods for wound repair.