股前外侧或股前内侧穿支皮瓣修复皮肤鳞状细胞癌切除后皮肤软组织缺损的临床效果

柳若冰; 郑德义; 王宝云; 李伟人

doi:10.3760/cma.j.cn501225-20231114-00193

股前外侧或股前内侧穿支皮瓣修复皮肤鳞状细胞癌切除后皮肤软组织缺损的临床效果

doi: 10.3760/cma.j.cn501225-20231114-00193

柳若冰¹,
郑德义^{1, 2, ,},
王宝云²,
李伟人¹

1.
贵州医科大学临床医学院，贵阳　　550001
2.
贵州省人民医院烧伤整形科，贵阳　　550002
3.
柳若冰现在贵州医科大学附属金阳医院皮肤科，贵阳　　550081

基金项目:

国家自然科学基金地区科学基金项目 81760021

详细信息

通讯作者:
郑德义，Email：deyizheng@126.com

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出版历程
- 收稿日期: 2023-11-14

Clinical effects of anterolateral femoral or anteromedial femoral perforator flaps in repairing skin and soft tissue defects after resection of cutaneous squamous cell carcinoma

1.
Clinical Medical College, Guizhou Medical University, Guiyang 550001, China
2.
Department of Burns and Plastic Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China
3.
Liu Ruobing is now working in the Department of Dermatology of Jinyang Hospital Affiliated to Guizhou Medical University, Guiyang 550081, China

Funds:

The Regional Science Fund of National Natural Science Foundation of China 81760021

More Information

Corresponding author: Zheng Deyi, Email: deyizheng@126.com

摘要

摘要: 目的探讨股前外侧或股前内侧穿支皮瓣修复皮肤鳞状细胞癌（CSCC）切除后皮肤软组织缺损的临床效果。方法该研究为回顾性观察性研究。2015年7月—2022年7月，贵州省人民医院烧伤整形科收治21例CSCC患者，其中男15例、女6例，年龄27~74岁。CSCC扩大切除后皮肤软组织缺损面积为7.5 cm×4.0 cm~23.0 cm×8.5 cm。18例患者创面采用股前外侧穿支皮瓣修复；术中观察到3例患者旋股外侧动脉降支穿支血管存在变异，采用股前内侧穿支皮瓣修复创面。皮瓣面积为8.0 cm×5.0 cm~25.0 cm×10.0 cm。将19例患者供瓣区创面直接缝合，采用对侧大腿薄中厚皮片修复2例患者供瓣区创面。观察术后皮瓣成活情况及血管危象发生情况。记录手术时长和住院天数。术后随访时，观察患者肿瘤复发情况、供受区外形、供瓣区功能等。末次随访时，评估患者对疗效的满意度。结果 20例患者术后皮瓣成活；1例患者于术后48 h内发生血管危象，立即行急诊手术处理后皮瓣成活。患者手术时长为4~5 h，住院15~38 d。术后随访1~6年见局部肿瘤无复发；皮瓣色泽、质地与周围组织差异不大，弹性良好，外形较佳；2例患者供瓣区皮片存活良好，出现局部色素沉着；所有患者供瓣区仅有线状瘢痕，感觉及运动功能无明显影响。末次随访时，对疗效满意者15例、一般者6例。结论对于CSCC切除后皮肤软组织缺损，可优先采用股前外侧穿支皮瓣修复，在旋股外侧动脉降支穿支血管存在变异的情况下，选择股前内侧穿支皮瓣修复。2种皮瓣切取面积大，可根据缺损组织量调整皮瓣面积，精准有效修复CSCC切除后皮肤软组织缺损，术后外观及功能良好。
- 创伤和损伤 /
- 穿支皮瓣 /
- 癌 /
- 皮肤鳞状细胞癌 /
- 血管变异 /
- 创面修复
Abstract: Objective To explore the clinical effects of anterolateral femoral or anteromedial femoral perforator flaps in repairing skin and soft tissue defects after resection of cutaneous squamous cell carcinoma (CSCC). Methods This study was a retrospective observational study. From July 2015 to July 2022, 21 patients with CSCC were treated in the Department of Burns and Plastic Surgery of Guizhou Provincial People's Hospital, including 15 males and 6 females, aged from 27 to 74 years. The area of skin and soft tissue defects after extended resection of CSCC was 7.5 cm×4.0 cm to 23.0 cm×8.5 cm. The wounds in 18 patients were repaired with anterolateral femoral perforator flaps; variations of perforating branch of the descending branch of lateral circumflex femoral artery were observed in 3 patients during the operation, and the wounds were repaired with anteromedial femoral perforator flaps. The flap areas were 8.0 cm×5.0 cm to 25.0 cm×10.0 cm. The wounds in the donor areas were sutured directly in 19 patients, and the wounds in the donor areas were repaired with thin and medium-thickness skin grafts in the contralateral thigh in 2 patients. The postoperative survival of flaps and the occurrence of vascular crisis were observed. The length of operation and the hospitalization day were recorded. The recurrence of tumor, the appearances of the donor and recipient areas of flaps, the function of the flap donor area were followed up. At the last follow-up, the satisfaction degree of patients for the curative effects was evaluated. Results The flaps survived in 20 patients, while the vascular crisis occurred in 1 patient within 48 hours after operation, and the flap survived after immediate emergency operation. The length of operation was 4 to 5 hours, and the hospitalization day was 15 to 38 days. The patients were followed up for 1 to 6 years after operation, there was no local tumor recurrence, the color and texture of the flaps were with no obvious differences to those of the surrounding tissue, and the elasticity and appearance were good. The skin grafts in the flap donor areas of 2 patients survived well with local pigmentation. There was only linear scar in the flap donor areas of all patients, and there were no significant effects on sensory and motor functions. At the last follow-up, fifteen patients were satisfied with the curative effect, and 6 patients were generally satisfied with the curative effect. Conclusions For skin and soft tissue defects after CSCC resection, the anterolateral femoral perforator flaps can be used preferentially. In the case of variation of the perforating branch of descending branch of the lateral circumflex femoral artery, the anteromedial femoral perforator flap is selected. The areas of the two flaps are large and can be adjusted according to the amount of defect tissue, thus accurately and effectively repairing skin and soft tissue defects after CSCC resection. The postoperative appearance and function are good.
- Wounds and injuries /
- Perforator flap /
- Carcinoma /
- Cutaneous squamous cell carcinoma /
- Vascular variation /
- Wound repair
柳若冰：研究设计，资料收集和整理，论文撰写；郑德义、王宝云：手术实施，研究设计和指导，论文修改；李伟人：论文修改

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参考文献(30)

[1]	WaldmanA,SchmultsC.Cutaneous squamous cell carcinoma[J].Hematol Oncol Clin North Am,2019,33(1):1-12.DOI: 10.1016/j.hoc.2018.08.001.
[2]	唐举玉,汪华侨,HallockGG,等.关注皮瓣供区问题—减少皮瓣供区损害专家共识[J].中华显微外科杂志,2018,41(1):3-5.DOI: 10.3760/cma.j.issn.1001-2036.2018.01.001.
[3]	SongYG,ChenGZ,SongYL.The free thigh flap: a new free flap concept based on the septocutaneous artery[J].Br J Plast Surg,1984,37(2):149-159.DOI: 10.1016/0007-1226(84)90002-x.
[4]	李海,肖顺娥,邓呈亮,等.不同类型游离穿支皮瓣组合在四肢复杂创面修复中的临床应用[J].中华烧伤与创面修复杂志,2023,39(8):758-764.DOI: 10.3760/cma.j.cn501225-20220720-00300.
[5]	唐举玉,贺继强,吴攀峰,等.股前外侧分叶-嵌合穿支皮瓣在四肢复杂创伤修复中的应用[J].中华显微外科杂志,2020,43(4):326-330.DOI: 10.3760/cma.j.cn441206-20190309-00089.
[6]	计鹏,曹涛,张智,等.股前外侧嵌合穿支皮瓣修复足踝部复杂创面的效果[J].中华烧伤与创面修复杂志,2023,39(10):926-932.DOI: 10.3760/cma.j.cn501225-20230627-00232.
[7]	任高宏,吴晓虎,陈允彪,等.股前外侧嵌合穿支皮瓣修复下肢复杂软组织缺损[J].中华显微外科杂志,2020,43(5):435-440. DOI: 10.3760/cma.j.cn441206-20200325-00173.
[8]	MoonP,PatelJV,MishraG,et al.Functional reconstruction of through and through cheek defect with free composite bi-pedalled anterolateral thigh flap[J].Indian J Otolaryngol Head Neck Surg,2023,75(2):649-653.DOI: 10.1007/s12070-022-03416-3.
[9]	HsiehF,LeowOQY,CheongCF,et al.Musculoseptocutaneous perforator of anterolateral thigh flap: a clinical study[J].Plast Reconstr Surg,2021,147(1):103e-110e.DOI: 10.1097/PRS.0000000000007471.
[10]	RammeltS,FritzscheH,HofbauerC,et al.Malignant tumours of the foot and ankle[J].Foot Ankle Surg,2020,26(4):363-370.DOI: 10.1016/j.fas.2019.05.005.
[11]	张浩,张晓东,庾东春,等.应用带蒂皮瓣修复皮肤软组织缺损[J].中华骨科杂志,2012,32(3):260-264.DOI: 10.3760/cma.j.issn.0253-2352.2012.03.013.
[12]	刘婷,徐立斌.皮肤鳞状细胞癌的诊疗现状及展望[J].中国医师进修杂志,2022,45(4):293-297.DOI: 10.3760/cma.j.cn115455-20211009-01200.
[13]	王宝云,肖向阳,郑德义,等.游离穿支皮瓣对前臂和手部电击伤创面的美学修复[J].中华整形外科杂志,2019,35(10):1004-1007.DOI: 10.3760/cma.j.issn.1009-4598.2019.10.011.
[14]	张警泓,刘剑毅,江旭品,等. 采用扩张桡动脉分叶皮瓣美学修复面部严重瘢痕挛缩畸形[J]. 中国美容整形外科杂志,2023,34(11):641-646,663. DOI: 10.3969/j.issn.1673-7040.2023.11.001.
[15]	杜伟力,沈余明,胡骁骅,等.供瓣区美学修复方法的探讨[J].中华烧伤杂志,2020,36(2):97-105.DOI: 10.3760/cma.j.issn.1009-2587.2020.02.004.
[16]	张国安. 注重创面修复的美学效果[J]. 中华烧伤杂志,2012,28(4):241-243. DOI: 10.3760/cma.j.issn.1009-2587.2012.04.001.
[17]	张家平,袁希,江旭品,等.基于“MRIS”原则采用扩张皮瓣美学整复颏颈部瘢痕挛缩畸形[J].中华烧伤与创面修复杂志,2022,38(4):306-312.DOI: 10.3760/cma.j.cn501120-20211130-00401.
[18]	郭鹏飞,王旭,魏爱周,等.基于供区保护理念的游离股前外侧分叶穿支皮瓣在头部电烧伤创面修复中的临床应用效果[J].中华烧伤与创面修复杂志,2022,38(1):77-80.DOI: 10.3760/cma.j.cn501120-20201111-00470.
[19]	高秋芳,张小锋,张万锋,等.股内侧肌穿支皮瓣修复游离股前外侧穿支皮瓣供区继发创面的临床效果[J].中华烧伤杂志,2019,35(1):65-68.DOI: 10.3760/cma.j.issn.1009-2587.2019.01.012.
[20]	张丕红.浅谈薄型穿支皮瓣切取与穿支血管探测和皮瓣血运评估[J].中华烧伤与创面修复杂志,2023,39(10):911-918.DOI: 10.3760/cma.j.cn501225-20230812-00047.
[21]	杨林,柳志锦,程俊楠,等.以肌间隔主干型旋股外侧动脉斜支为蒂的股前外侧穿支皮瓣解剖特点与临床应用[J].中华烧伤与创面修复杂志,2022,38(12):1133-1139.DOI: 10.3760/cma.j.cn501225-20220227-00039.
[22]	BocaR,KuoYR,HsiehCH,et al.A reliable parameter for primary closure of the free anterolateral thigh flap donor site[J].Plast Reconstr Surg,2010,126(5):1558-1562.DOI: 10.1097/PRS.0b013e3181ef8cb7.
[23]	徐达传, 钟世镇, 刘牧之, 等.股前外侧部皮瓣的解剖学:一个新的游离皮瓣供区[J].临床应用解剖学杂志,1984,2(3):158-160. DOI: 10.13418/j.issn.1001-165x.1984.03.012.
[24]	LeeYC,ChenWC,ChouTM,et al.Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications[J].Plast Reconstr Surg,2015,135(4):1097-1107.DOI: 10.1097/PRS.0000000000001103.
[25]	SmithRK,WykesJ,MartinDT,et al.Perforator variability in the anterolateral thigh free flap: a systematic review[J].Surg Radiol Anat,2017,39(7):779-789.DOI: 10.1007/s00276-016-1802-y.
[26]	郑咏舰,魏在荣,李海,等.股前内侧穿支皮瓣在下肢软组织缺损修复中的应用[J].中国修复重建外科杂志,2019,33(12):1552-1555.DOI: 10.7507/1002-1892.201905019.
[27]	YuP.Inverse relationship of the anterolateral and anteromedial thigh flap perforator anatomy[J].J Reconstr Microsurg,2014,30(7):463-468.DOI: 10.1055/s-0034-1370361.
[28]	YoshidaS,KoshimaI,ImaiH,et al.Investigation of flow velocity in recipient perforator artery for a reliable indicator for the flap transfer with perforator to perforator anastomosis[J].Microsurgery,2021,41(6):550-556.DOI: 10.1002/micr.30783.
[29]	唐举玉,王玉玲,吴攀峰,等.显微削薄-嵌合旋股外侧动脉降支穿支皮瓣修复四肢复杂软组织缺损[J].中华显微外科杂志,2021,44(6):621-624.DOI: 10.3760/cma.j.cn441206-20210125-00031.
[30]	MengF,AndreaS,ChengS,et al.Modified subcutaneous buried horizontal mattress suture compared with vertical buried mattress suture[J].Ann Plast Surg,2017,79(2):197-202.DOI: 10.1097/SAP.0000000000001043.

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1 右股前外侧穿支皮瓣修复例1患者左小腿皮肤鳞状细胞癌切除后皮肤软组织缺损的效果。1A.术前皮肤破溃伴部分胫骨外露及缺损；1B.创面清创后即刻，左小腿创面可见少量肉芽组织，部分胫骨外露及缺损；1C.术前皮瓣设计；1D.术中受区采用抗生素骨水泥填充；1E.术中皮瓣切取后即刻；1F.术中皮瓣覆盖创面后即刻；1G.术后2周，受区拆线后见皮瓣色泽与周围组织差异不大；1H.术后12个月随访时，供受区外形较佳

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2 左股前内侧穿支皮瓣修复例2患者右额部皮肤鳞状细胞癌切除后皮肤软组织缺损的效果。2A.入院时右额部病灶呈“火山口”状，中央破溃并坏死；2B.术前皮瓣设计；2C.术中皮瓣切取；2D.术中见右眉上额部皮肤及额肌缺损、眶上神经缺损及骨外露，完整切取皮瓣后；2E.术中皮瓣覆盖创面并缝合后即刻；2F.供瓣区创面缝合后即刻；2G.术后2周受区拆线后即刻，皮瓣稍臃肿；2H.术后14个月随访时，受区外形较佳

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