改良菱形皮瓣转移术修复面部基底细胞癌切除术后组织缺损临床效果观察

来源:用户上传      作者:王路　刘柱　张俊

　　[摘要]目的：探讨针对面部基底细胞癌切除术后的组织缺损使用改良菱形皮瓣转移术修复的临床效果。方法：对笔者医院2015年4月-2020年4月收治的54例面部基底细胞癌患者行面部基底细胞癌切除术，缺损部位采用改良菱形皮瓣转移术修复。对术后患者皮瓣成活、创面愈合以及术后随访情况进行总结。结果：本组54例中，术后皮瓣全部成活，创面一期愈合，成活率100.00%。供区未见感染病例，愈合良好。54例患者均获随访，随访时间9～12个月。随访结果皮瓣血运良好，质地柔软，厚薄适中，外形无臃肿;术区未见明显瘢痕残留，无局部牵拉变形情况，外观形态及局部结构功能正常，无复发病例，治愈率100.00%。结论：改良菱形皮瓣设计灵活、取材简便、手术操作简单，术后皮瓣血运重建迅速、成活率高，局部外观形态及功能恢复较好，是修复面部基底细胞癌切除术后组织缺损的理想皮瓣。
　　[关键词]面部;基底细胞癌;组织缺损;改良菱形皮瓣;转移术;成活率;创面愈合
　　[中图分类号]R739.5 [文献标志码]A [文章编号]1008-6455（2022）01-0034-03
　　Observation on the Effect of Modified Rhomboid Skin Flaps to Repair Tissue Defects after Facial Basal Cell Carcinoma Resection
　　WANG Lu，LIU Zhu，ZHANG Jun
　　（Department of Plastic Surgery，General Hospital of Anhui Suzhou Wanbei Coal Power Group，Suzhou 234000，Anhui，China）
　　Abstract： Objective To explore the clinical effect of using modified rhomboid flap metastasis to repair tissue defects after facial basal cell carcinoma resection. Methods 54 cases of facial basal cell carcinoma patients admitted to the author’s hospital from April 2015 to April 2020 underwent facial basal cell carcinoma resection， and the defect was repaired by modified rhomboid flap metastasis. The survival of skin flaps， wound healing and postoperative follow-up were summarized. Results In 54 cases in this group， all flaps survived the operation， the wound healed by first intention， survival rate was 100.00%. There were no cases of infection in the donor site and healed well. All 54 patients were followed up for 9 to 12 months. Follow-up results showed that the skin flap had good blood supply， its texture was soft， its thickness was moderate， and its shape was not bloated. There was no obvious residual scar， local traction and deformation in the operation area， and its appearance， shape and local structure and function were normal. There was no recurrence， and the cure rate is 100.00%. Conclusion The modified rhomboid flap is flexible in design， simple in material extraction， and simple in operation. The postoperative flap has rapid revascularization， high survival rate， and good local appearance and function recovery. It is an ideal skin for repairing tissue defects after facial basal cell carcinoma resection.
　　Key words： face; basal cell carcinoma; tissue defect; modified rhomboid flap; transplantation; survival rate; wound healing
　　基底细胞癌是一种恶性程度较低的皮肤癌，多见于老年人，好发于颜面部等曝光部位，在面部尤其以颊部、鼻沟旁、前额等处多见[1]。基底细胞癌切除术是治疗面部皮肤癌的常用治疗方法，多数患者经手术治疗后疗效显著[2]。面部基底细胞癌根治术后造成的组织缺损对患者的外在形象、局部功能影响极大，故而修复组织缺损亦是面部皮w癌治疗中关键的一环[3-4]。目前修复面部组织缺损的方法较多，包括局部皮瓣、游离皮瓣、直接缝合、皮片移植等[5]。由于基底细胞癌术后创面较大、移植皮片与面部皮肤有差异，因此直接缝合、皮片移植等缺损组织的修复方法并不适用于颊面部缺损[6-7]。改良菱形皮瓣转移术是局部皮瓣术中的一种，其通过旋转与推进结合的方法将缺损部位邻近皮瓣直接覆盖缝合于创面，在面部组织缺损修复中的应用价值已得到临床工作者的广泛认可[8-9]。近年来，笔者科室将改良菱形皮瓣移植术应用于面部基底癌切除术后组织缺损的修复中，并取得较好的成效，具体报道如下。
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