局部皮瓣修复鼻部非黑素瘤皮肤癌切除后缺损

Repair the Defect after the Operation of Nasal Non-Melanoma Skin Cancer with Local Flap

目的探讨应用局部皮瓣一期修复鼻部非黑素瘤皮肤癌切除后缺损的方法和效果。方法2017年1月—2020年1月收治鼻部非黑素瘤皮肤癌患者67例。其中基底细胞癌(BCC)58例,鳞状细胞癌(cSCC)9例,所有患者病变局限且未发现转移证据。手术切除肿瘤后根据缺损的大小、形状、位置及周围皮肤情况,遵循鼻亚单位分区及美学原则,设计局部皮瓣进行一期修复。皮瓣大小为1.5 cm×1.5 cm~3.5 cm×4.0 cm,其中菱形皮瓣19例,鼻唇沟皮瓣15例,双叶皮瓣12例,V-Y皮瓣11例,眉间皮瓣10例。结果67例患者中,60例皮瓣创面一期愈合,7例皮瓣远端部分表皮坏死(缺血性),经换药后愈合;皮瓣供区创面一期愈合。全部患者术后随访12~36个月,肿瘤无复发。鼻部外形轮廓良好,皮瓣与周围皮肤颜色、质地匹配良好,瘢痕不明显。结论鼻部非黑素瘤皮肤癌切除后,遵循鼻美学亚单位原则,根据缺损创面的大小、位置、形状及周围皮肤情况选用合适的局部皮瓣进行修复,可以取得较好的整形美容效果。

Objective To explore the efficacy and method of local flap in one-stage reconstructing nasal defect after non-melanoma skin cancer excision.Methods From January 2017 to January 2020,according to the size,shape,location of nasal defect,the condition of surrounding skin,and the nasal aesthetic subunit principle,homologous local flap was designed to cover the nasal defect in 67 cases with nasal non-melanoma skin cancer.Among 67 cases,there were 58 cases of basal cell carcinoma and 9 cases of squamous cell carcinoma.The clinical stage of malignant carcinoma was 0-I stage.The area of the local flaps ranged between 1.5 cm×1.5 cm and 3.5 cm×4.0 cm.The types of flaps were rhomboid flap in 19 cases,nasolabial flap in 15 cases,bilobed flap in 12 case,V-Y flap in 11 cases and glabella flap in 10 cases.Results Among 67 cases,60 cases acquired complete recovery;7 cases which had epidermal necrosis over the far end of the flap achieved healing by the first intention after regional change dressings.The nasal defect was successfully repaired in all patients,and the all flaps survived.A total of 67 patients were available for follow-up of 12 to 36 months,no carcinoma recurrence occurred,the repaired tissue were good match with surrounding tissue,good nasal contour was obtained,and the cosmetic results were satisfactory.Conclusion Based on the nasal aesthetic subunit principle,according to the size,shape,location of nasal defect and the conditions of surrounding skin,the local flap can reconstruct the nose defect after cutaneous carcinoma excision and the cosmetic results are satisfactory.