局部皮瓣修复头面颈部皮肤肿瘤切除后缺损(1)
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[摘要]目的：探讨局部皮瓣一期修复头面颈部皮肤肿瘤切除后缺损的效果。方法：2006年1月～2010年12月收治155例头面颈部皮肤肿瘤病例，采取将肿瘤及其边缘0.1～3cm正常组织一起切除并彻底清创的方法，综合考虑创面的性质、部位、大小等因素，设计局部皮瓣一期修复切除后遗留的创面，术后随访期6个月～2年。结果：本组155例患者的切口均I期愈合，皮瓣全部成活。术后随访6个月～2年，形态、功能良好，瘢痕不明显，无并发症，效果满意。结论：采用局部皮瓣I期修复头面颈部皮肤软组织缺损(大小2.0cm×1.5cm～7.0cm×4.0cm)，手术简单易行、适应证广、疗效较好，是比较理想的方法。
[关键词]头面颈部；皮肤肿瘤；皮瓣；皮肤缺损；修复
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2011)10-1508-03
Application of local skin flap for skin tumor of scalp and face or neck after surgical ablation
ZHAO Wen-bin,YE Jian-zhou,YANG En-pin,OUYANG Xiao-yong,YANG Jin
(Department of Dermatology,Affilated Hospital of Yunnan College of Traditional Chinese Medicine(TCM),Kunming 650021,Yunnan,China)
Abstract:ObjectiveTo investigate the effect and advantage of using local skin flap for the reconstruction of medium-sized skin and soft tissue defect.MethodsFrom January 2006 to December 2010,Skin and soft tissue defect on the head ,face or neck in 155 patients were repaired with local skin flaps , according to the lesion type,location,and size,tumors were excised including the 0.1 to 3cm normal tissue around the tumor and the wounds were debrided completely.The defects were immediately repaired by using local skin flap.After operation,all patients were persevered to follow up for 6 months to 2 years. ResultsFlaps in all155 patients survived with primary healing postoperatively. All patients were followed for 6 months to 2 years,the postoperative contour and function was satisfactory. No complication occurred .All patients were satisfied with the cosmetic appearance.ConclusionThe local skin flap is an effective way to repair skin and soft tissue defect on the head ,face or neck.The size of the defect which were repaired ranged from 2.0cm×1.5cm to 7.0cm×4.0cm. Operation is simple ,indication is extensive and results are satisfactory.
Key words:scalp and face or neck;skin tumor;flap;skin defect;repair
头面颈部皮肤缺损的修复在外观上要求较高，应尽量做到术后瘢痕不明显，外观较平整。笔者自2006年1月～2010年12月采用各种局部皮瓣修复头面颈部皮肤肿瘤切除后缺损患者155例,术后效果满意,现报道如下。
1临床资料
本组患者共155例,其中男89例，女66例, 年龄8～67岁。皮肤缺损原因:色素痣61例，血管瘤22例，皮脂腺痣19例，瘢痕19例，基底细胞癌16例, 鳞状细胞癌9例，脂溢性角化9例。缺损部位：头皮58例，面部55例，颈部42例。缺损面积2.0cm×1.5cm～7.0cm×4.0cm。皮瓣设计最大为8cm×4.5cm,最小为2cm×1.5cm。术后均经组织病理检查确诊。
2治疗方法
术前拍摄皮损部位照片,围绕皮损画出切除范围线，良性者切除线距皮损边缘1～2mm，恶性者切除线距皮损边缘5～30mm。采用利多卡因局部浸润麻醉,沿画线切除皮损，深达皮下浅筋膜, 恶性者达深筋膜表面，若肿瘤基底与肌肉有粘连则切除部分肌肉。再在缺损旁选择适当的供区皮肤设计皮瓣，依据头面颈部分区及器官的亚单位分区原则设计皮瓣，并且尽量使切口线与皮肤张力线方向一致 ......
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