纵向黑甲切除术后创面修复的治疗体会

Treatment experience of wound repair after longitudinal melanonychia resection

目的对手部纵向黑甲的良恶性进行初步鉴别, 并探讨外科切除术后甲床缺损创面的皮瓣修复方法。方法自2017年9月至2022年5月, 我们共收治手部黑甲患者28例, 其中16岁以下的有6例;拇指9例, 其他手指19例。术前对纵向黑甲的良恶性进行初步鉴别, 并预估黑甲切除后甲床缺损范围, 对于缺损宽度小于甲床宽度1/2的采用横行V-Y推进皮瓣修复, 大于甲床宽度1/2的在切除全部甲单元后予指背筋膜蒂皮瓣修复。结果术后28例皮瓣均存活, 指背筋膜蒂皮瓣有5例术后早期出现静脉回流障碍, 经处理后皮瓣存活。术后病理报告:甲母痣16例, 交界痣10例, 原位黑素瘤2例。24例患者随访9~24个月。V-Y推进皮瓣组有17例获得随访, 其中14例指甲生长良好, 3例出现纵嵴;指背筋膜蒂皮瓣组有7例获得随访, 皮瓣外形及质地均较满意。所有随访患者均未见复发。结论根据纵向黑甲切除后甲床缺损范围的不同, 采用横行V-Y推进皮瓣或指背筋膜蒂皮瓣进行修复均取得较好的临床效果, 同时也对黑甲治疗规范的建立进行了有意义的探索。

Objective To conduct preliminary differentiation of benign and malignant longitudinal melanonychia in the hand,the explore the flap repair methods for nail bed defects after surgical resection.Methods From September 2017 to May 2022,a total of 28 patients with hand melanonychia were treated.Among them,there were 6 cases under the age of 16 and 9 cases in thumbs.The preliminary differentiation of benign and malignant longitudinal melanonychia before surgery was conducted and the area of nail bed defects after melanonychia excision was estimated.For defects with a width less than 1/2 of the nail bed width,a transverse V-Y advancement flap was used for repair.For defects with a width greater than 1/2 of the nail bed width,a digital dorsal fascia flap was used for repair after nail unit total resection.ResultsAll 28 flaps survived after surgery.The early postoperative venous reflux obstruction occurred in 5 cases of digital dorsal fascia flap.After appropriate treatment,all 5 flaps survived.The postoperative pathological report showed that 16 cases were nail matrix nevi,10 cases were junctional nevi,and 2 cases were melanoma in situ.24 patients were follow-up for a period of 9 to 24 months.i7 cases in the V-Y advancement flap group were obtained follow-up.Among them,14 cases reacquired fine nail,and 3 cases had longitudinal ridges in their nails.7 cases in the digital dorsal fascia flap group were obtained follow-up.The appearance and texture of the flap were satisfactory.At the last follow-up,no recurrence was observed in all follow-up patients.Conclusion According to the different range of nail bed defects after longitudinal melanonychia resection,the use of transverse V-Y advancement flap or digital dorsal fascia flap for repair has achieved good clinical results,and also made meaningful exploration for the establishment of standardized treatment for longitudinal melanonychia.