局部皮瓣在面部皮肤病变切除后缺损修复中的应用

To reconstruct facial defects after removing skin lesions by using local flap

目的:探讨局部皮瓣在面部皮肤缺损修复中的应用和效果。方法:53例(男30例,女23例)面部皮肤病变患者。经手术彻底切除病变,恶性肿瘤切除严格无瘤原则,术中冷冻切片病理检查确认切缘阴性;良性病变切净病灶即可。根据缺损部位选用合适的局部皮瓣修复缺损:改良V-Y推进皮瓣13例、鼻唇沟转移皮瓣8例、A/O-T形皮瓣8例、旋转皮瓣6例、直接滑行瓣5例、多型皮瓣联合6例、双叶瓣2例、棱形皮瓣2例、游离皮瓣3例。结果:术后良性病变随访10~12个月,恶性肿瘤随访12~36个月,均无失访;恶性肿瘤者中有2例术后半年局部复发再手术切除;皮瓣远端表皮部分坏死5例,经湿敷、换药渐愈;创面裂开1例,再缝后愈合。其余皮瓣均一期愈合.全组无血肿、睑外翻、唇部变形等并发症发生。结论:局部皮瓣类型多样,可灵活选用来修复面部皮肤缺损。修复技术是术者的底气,只有掌握了基本的修复手段,才敢大胆地切除病变,最终获得满意疗效。

Objective:The aim of this study is to investigate the method and effect of reconstruction of facial skin defects after removing the lesions by applying local flap.Method:Fifty-three patients(30 males and 23 females)with facial skin lesions.Complete surgical resection of the lesion;malignant tumor resection should be strictly non-tumor principle;intraoperative frozen section pathological examination confirmed negative margin;benign lesions can be cut off the lesion.According to the defect site,the appropriate local flap was used to repair the defect:13 cases of modified VY propulsion flap,8 cases of nasolabial flap,8 cases of A/O-T shaped flap,6 cases of rotating flap,5 cases of direct sliding flap,multi-type There were 6 cases with flap,2 cases with double leaf,2 cases with prismatic flap and 3 cases with free flap.Result:Patients with malignant tumor were followed for 12-36 months postoperatively while followed for 10-12 months in the benign.Two patients with malignant tumor developed local recurrence and removed again.At half a year after first resection.Distal partial necrosis occurred in 5 cases while the wound dehiscence in1 case,others were well developed.No others major complications occurred.Conclusion:There are various types of local skin flap for repairing facial skin defects.It is very important to excise the primary lesion radically before reconstruction,the satisfactory curative effect can be obtained through reasonable design of the flap.