颞浅动脉分叶穿支皮瓣修复颞区肿瘤切除后皮肤软组织缺损的临床效果

廖晓霜; 陈伟; 蒋海芳; 周健; 魏在荣; 常树森; 张芳; 聂开瑜

doi:10.3760/cma.j.cn501225-20220816-00347

颞浅动脉分叶穿支皮瓣修复颞区肿瘤切除后皮肤软组织缺损的临床效果

doi: 10.3760/cma.j.cn501225-20220816-00347

遵义医科大学附属医院烧伤整形外科，遵义　　563003

基金项目:

省部共建协同创新中心项目 2020-39

详细信息

通讯作者:
聂开瑜，Email：1147900529@qq.com

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出版历程
- 收稿日期: 2022-08-16

Clinical effects of superficial temporal artery lobulated perforator flaps in repairing skin and soft tissue defects after temporal tumor resection

Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China

Funds:

Collaborative Innovation Center of Chinese Ministry of Education 2020-39

More Information

Corresponding author: Nie Kaiyu, Email: 1147900529@qq.com

摘要

摘要: 目的探讨应用颞浅动脉分叶穿支皮瓣修复颞区肿瘤切除后皮肤软组织缺损的可行性和临床效果。方法采用回顾性观察性研究方法。2017年3月—2022年10月，遵义医科大学附属医院收治颞区皮肤肿瘤患者10例，其中女6例、男4例，年龄42~87岁，鳞状细胞癌者3例、基底细胞癌者7例，病程为6个月~5年。对所有颞区肿瘤均行扩大切除，肿瘤切除后遗留创面面积为5.4 cm×4.2 cm~7.0 cm×4.0 cm。设计颞浅动脉额支皮瓣（面积为5.5 cm×1.2 cm~7.0 cm×1.5 cm）、颞浅动脉下行支皮瓣（面积为4.2 cm×3.5 cm~5.0 cm×4.0 cm）及颞浅动脉顶支皮瓣（面积为4.2 cm×1.0 cm~5.0 cm×1.0 cm）修复创面并重建发际线。将皮瓣供区直接拉拢缝合。术后3~5 d观察皮瓣成活情况，术后5~7 d拆线时观察供受区创面愈合情况。术后随访时，观察患侧颞区外观、瘢痕增生情况、发际线重建情况及肿瘤复发情况。结果术后3~5 d所有皮瓣存活良好。术后5~7 d所有供受区创面愈合良好。术后3~6个月随访时，术区切口隐蔽，皮瓣不臃肿且色泽与周围皮肤无明显差异，未见明显瘢痕增生，患侧重建发际线与健侧无明显差异，局部肿瘤均无复发。结论针对颞区的大面积皮肤软组织缺损，应用颞浅动脉分叶穿支皮瓣可在分区修复创面的同时Ⅰ期缝合供区，手术操作简便，术后面部外观符合美学要求，局部肿瘤均无复发，修复效果良好。本术式特别适合老年患者颞区大面积皮肤软组织缺损的修复。
- 外科皮瓣 /
- 面部肿瘤 /
- 颞浅动脉 /
- 创面修复 /
- 颞区
Abstract: Objective To explore the feasibility and clinical effects of using superficial temporal artery lobulated perforator flaps in repairing skin and soft tissue defects after tumor resection in the temporal region. Methods A retrospective observational study method was used. From March 2017 to October 2022, ten patients with temporal skin tumors were admitted to the Affiliated Hospital of Zunyi Medical University, including six women and four men, with age ranging from 42 to 87 years. Among them, three patients had squamous cell carcinoma and seven patients had basal cell carcinoma, with disease duration ranging from 6 months to 5 years. All temporal tumors underwent expanded resection, leaving wound areas of 5.4 cm×4.2 cm to 7.0 cm×4.0 cm after tumor resection. Superficial temporal artery frontal branch flaps with areas of 5.5 cm×1.2 cm to 7.0 cm×1.5 cm, superficial temporal artery descending branch flaps with areas of 4.2 cm×3.5 cm to 5.0 cm×4.0 cm, and superficial temporal artery parietal branch flaps with areas of 4.2 cm×1.0 cm to 5.0 cm×1.0 cm were designed to repair the wounds and reconstruct the hairline. The donor areas of the flaps were closed and sutured directly. The survival of the flaps was observed on 3 to 5 days after surgery, and the healing of wounds on the donor and recipient sites was observed when the stitches were removed on 5 to 7 days after surgery. During follow-up after surgery, the appearance of the temporal area, scar hyperplasia, hairline reconstruction, and tumor recurrence were observed in the temporal region on the affected side. Results All the flaps survived well on 3 to 5 days after surgery, and all the donor and recipient site wounds healed well on 5 to 7 days after surgery. During follow-up of 3 to 6 months after surgery, the surgical incisions were concealed; the flaps were not swollen, with a consistent color to the surrounding skin; there were no obvious hypertrophic scars; the reconstructed hairline on the affected side was not significantly different from that of the healthy side; there was no tumor recurrence in the local area. Conclusions For large areas of skin and soft tissue defects in the temporal region, the use of superficial temporal artery lobulated perforator flaps can repair the wounds in different regions and suture the donor sites in the primary stage simultaneously. The surgical operation is simple, and the facial appearance conforms to the aesthetic requirement after surgery with no tumor recurrence in the local area but a good repair effect. This method is particularly suitable for repairing large areas of skin and soft tissue defects in the temporal region in elderly patients.
- Surgical flaps /
- Facial neoplasms /
- Superficial temporal artery /
- Wound repair /
- Temporal region
廖晓霜：研究设计、实施手术、采集数据、论文撰写；陈伟、蒋海芳、周健：病例资料采集和分析指导；魏在荣、聂开瑜：研究的整体设计和指导、实施手术、对文章的知识性内容作批评性审阅；常树森、张芳：技术支持、论文修改

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参考文献(33)

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1 颞浅动脉分叶穿支皮瓣设计示意图

注：a点和b点间的连线为颞区发际线，a1点为下行支皮瓣远端，b1点为顶支皮瓣近端，b2点为下行支皮瓣近端，c点为b点斜上方创周的1点，d点为额支皮瓣远端，e点为额支皮瓣近端；灰色圆形示颞区肿瘤切除后创面，蓝色椭圆形示颞浅动脉顶支皮瓣，绿色椭圆形示颞浅动脉额支皮瓣，橙色椭圆形示颞浅动脉下行支皮瓣；蓝色箭头示颞浅动脉顶支，绿色箭头示颞浅动脉额支，红色箭头示颞浅动脉下行支

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2 颞浅动脉分叶穿支皮瓣修复患者左面部鳞状细胞癌术后皮肤软组织缺损的效果。2A.术前患侧颞区大面积溃疡伴组织液渗出；2B.患侧颞浅动脉皮瓣设计；2C.术中病灶扩大切除后；2D.颞浅动脉顶支（蓝色箭头）皮瓣切取后；2E.颞浅动脉下行支（黑色箭头）皮瓣切取后及颞浅动脉额支（绿色箭头）皮瓣切取后；2F.皮瓣覆盖创面并缝合后即刻；2G.术后6个月随访，患侧眶周无明显瘢痕增生与牵拉；2H.术后6个月随访，患侧发际线形态良好，手术切口瘢痕位于毛发内不易察觉

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