股前外侧穿支皮瓣移植修复头面颈部皮肤恶性肿瘤根治性切除后创面的临床效果

孙向东; 李成志; 悟拉木·艾力; 麦吉米·司马义; 达成利; 张兴琴; 艾合麦提江·艾合太尔; 阿布都赛米江·阿西木; 吴源泉

doi:10.3760/cma.j.cn501225-20240920-00341

股前外侧穿支皮瓣移植修复头面颈部皮肤恶性肿瘤根治性切除后创面的临床效果

doi: 10.3760/cma.j.cn501225-20240920-00341

1.
喀什地区第一人民医院烧伤整形外科,喀什　　844000
2.
喀什地区第一人民医院口腔颌面外科,喀什　　844000
3.
喀什地区第一人民医院手术室,喀什　　844000
4.
喀什地区第一人民医院普通外科中心,喀什　　844000

基金项目:

喀什地区科技局2021年科技计划项目 KS2021079

详细信息

通讯作者:
吴源泉,Email：wyqksrmyy@163.com

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出版历程
- 收稿日期: 2024-09-20

Clinical effects of the anterolateral thigh perforator flaps transplantation in repairing the wounds after radical resection of skin malignant tumors in the head, face, and neck

1.
Department of Burns and Plastic Surgery, the First People's Hospital of Kashi Prefecture, Kashi 844000, China
2.
Department of Oral and Maxillofacial Surgery, the First People's Hospital of Kashi Prefecture, Kashi 844000, China
3.
Department of Operating Theatre, the First People's Hospital of Kashi Prefecture, Kashi 844000, China
4.
Department of General Surgery Center, the First People's Hospital of Kashi Prefecture, Kashi 844000, China

Funds:

2021 Science and Technology Plan of Kashi Prefecture Science and Technology Bureau KS2021079

More Information

Corresponding author: Wu Yuanquan, Email: wyqksrmyy@163.com

摘要

摘要: 目的探讨股前外侧穿支皮瓣移植修复头面颈部皮肤恶性肿瘤根治性切除后创面的临床效果。方法该研究为回顾性观察性研究。2020年5月—2023年12月,喀什地区第一人民医院烧伤整形外科收治27例符合入选标准的头面颈部皮肤恶性肿瘤患者,其中男19例、女8例,年龄53~89岁。肿瘤为鳞状细胞癌者21例、基底细胞癌者6例。肿瘤根治性切除后创面面积为9.0 cm×7.0 cm~27.0 cm×21.5 cm。采用分叶、组合或多种形式联合的股前外侧穿支皮瓣修复创面,单侧供区皮瓣切取面积为10.0 cm×8.0 cm~27.0 cm×11.0 cm。将26例患者供区创面拉拢缝合,1例患者供区创面取小腿中厚皮修复。观察术后皮瓣成活情况、血管危象和感染发生情况。术后随访时,观察肿瘤复发情况、皮瓣外形和质地、供区所在肢体功能及瘢痕形成情况。结果仅1例患者术后27 h出现皮瓣静脉危象,经血管探查并重新吻合静脉后皮瓣成活；其余患者术后皮瓣完全成活。1例患者术后皮瓣下出现感染积液,经换药治疗后愈合。术后随访6~36个月,未见肿瘤复发；皮瓣外观、质地及弹性良好；供区所在肢体功能正常,仅遗留线性瘢痕。结论对于头面颈部皮肤恶性肿瘤根治性切除后的复杂创面,可根据创面情况采用不同形式股前外侧穿支皮瓣修复,术后受区创面愈合良好,供区损害小。
- 穿支皮瓣 /
- 显微外科手术 /
- 皮肤肿瘤 /
- 创面修复
Abstract: Objective To investigate the clinical effects of the anterolateral thigh perforator flaps transplantation in repairing the wounds after radical resection of skin malignant tumors in the head, face, and neck. Methods This study was a retrospective observational study. From May 2020 to December 2023, 27 patients with skin malignant tumors in the head, face, and neck were admitted to the Department of Burns and Plastic Surgery of the First People's Hospital of Kashi Prefecture, including 19 males and 8 females, aged 53 to 89 years. There were 21 cases with squamous cell carcinoma and 6 cases with basal cell carcinoma. The wound area after radical resection of tumors was 9.0 cm×7.0 cm to 27.0 cm×21.5 cm. The wounds were repaired with the lobulated, combined, or various forms of combination of the anterolateral thigh perforator flaps, and the harvesting flap area in single donor site was 10.0 cm×8.0 cm to 27.0 cm×11.0 cm. The wounds in the flap donor sites were closed by suturing in 26 patients, while the wound in the flap donor site in 1 patient was repaired with medium-thickness skin graft in the lower leg. The survival of the flap, and the occurrence of vascular crisis and infection were observed after surgery. During follow-up after surgery, the tumor recurrence, shape and texture of the flaps, and the function and scar formation of the limbs where the donor site was located were observed. Results Only one patient developed venous crisis of the flap 27 hours after surgery, and the flap survived after vascular exploration and reanastomosis of the vein; the flaps in the other patients survived after surgery. One patient had an infected effusion under the flap after surgery, which healed after dressing change. After 6-36 months of postoperative follow-up, no tumor recurrence was observed; the flap had good appearance, texture, and elasticity; the limb where the donor site was located functioned normally, with only linear scars left. Conclusions For complex wounds after radical resection of skin malignant tumors in the head, face, and neck, different forms of anterolateral thigh perforator flaps can be used to repair the wounds according to the condition of the wounds, and the wounds in the recipient sites heal well after surgery, with minimal damage to the donor site.
- Perforator flap /
- Microsurgery /
- Skin neoplasms /
- Wound repair
孙向东：实施手术,收集、整理数据,起草、撰写文章,修改并完善文章；李成志、麦吉米·司马义：实施手术,采集、分析、解释数据；悟拉木·艾力：病例随访,采集、分析数据,参与文章撰写；达成利、张兴琴、艾合麦提江·艾合太尔、阿布都赛米江·阿西木：实施手术,病例随访,采集数据；吴源泉：指导、统筹安排手术,保障手术的顺利完成,修改、完善文章,对文章的知识性内容进行批评性审阅

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图 1 分叶股前外侧穿支皮瓣修复例1患者头皮鳞状细胞癌根治性切除后创面的效果。1A.术前头部肿瘤情况；1B.肿瘤根治性切除后可见部分颅骨、硬脑膜、脑组织外露；1C.术中设计分叶穿支皮瓣；1D.术中切取的阔筋膜（黑色箭头）用于修补硬脑膜缺损；1E.术中移植阔筋膜（黑色箭头）修补硬脑膜缺损；1F.术中皮瓣切取完成,血管蒂解剖完毕；1G.术中将皮瓣分叶后；1H.术后3 d皮瓣成活；1I.术后1年,头部及皮瓣外观良好；1J.术后1年,供区遗留线性瘢痕,屈髋屈膝功能正常

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图 2 组合股前外侧穿支皮瓣修复例2患者头皮鳞状细胞癌根治性切除后创面的效果。2A.术前头部肿瘤正面观；2B.术前头顶部肿瘤情况；2C.术中根治性切除肿瘤后可见颅骨外露；2D.术中清扫左侧颈部淋巴结后,未见明显肿大淋巴结残留；2E.右侧皮瓣设计；2F.右侧皮瓣切取完成,可见皮瓣携带2条穿支血管并共干于旋股外侧动脉降支；2G.左侧皮瓣设计；2H.左侧皮瓣切取完成,可见皮瓣携带2条穿支血管并共干于旋股外侧动脉降支；2I.术后1年,皮瓣无明显臃肿；2J.术后1年,供区仅遗留线性瘢痕

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图 3 分叶-联体-嵌合股前外侧穿支皮瓣修复例3患者颈部皮肤鳞状细胞癌根治性切除后创面的效果。3A.术前左侧颈部肿瘤外观；3B.行肿瘤根治性切除及左侧颈部淋巴结清扫后,可见颈外静脉外露及创面死腔形成,未见腮腺及面神经受累；3C.术中于左侧大腿设计分叶皮瓣；3D.术中皮瓣切取完毕,可见皮瓣携带2条穿支血管共干于旋股外侧动脉降支,皮瓣远端携带1条股动脉远端发出的穿支血管；3E.术中分成2个皮瓣后,2个皮瓣均由独立的血管供血；3F.皮瓣移植术后即刻；3G.供区缝合后即刻；3H.术后2个月,皮瓣轻度臃肿

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