3种邻位皮瓣修复头面部肿瘤切除术后皮肤缺损的疗效分析

Efficacy analysis of three adjacent skin flaps in repairing postoperative skin defect after head and facial tumor resection

关键词:  邻位皮瓣  修复  皮肤缺损  肿瘤

Key words:  adjacent skin flap  reconstruction  skin defect  tumor

摘要:

目的　比较评价3种邻位皮瓣修复头面部肿瘤切除术后皮肤缺损的临床应用效果。方法　收集35例头面部肿瘤切除术后皮肤缺损患者，分别采用菱形皮瓣（15例）、双侧推进皮瓣（8例）和A-T皮瓣（12例）进行修复，并比较评价其临床效果。结果　术后所有皮瓣均成活，无感染坏死，创口一期愈合。术后随访1～2年，所有病例均未发现颈部转移和局部复发。2例患者术后出现抬头纹消失面瘫体征，菱形皮瓣中有2例患者术后眼部略有牵拉变形。菱形皮瓣在瘢痕平整度方面要明显优于双侧推进皮瓣和A-T皮瓣，差异具有统计学意义（P＜0.05）。结论　邻位皮瓣修复头面部肿瘤切除术后皮肤缺损，患者功能和外形恢复较好，是头面部缺损修复重建的理想选择。3种皮瓣各有优缺点，术中需根据实际情况灵活选用。

Abstract:

Objective To compare and evaluate the clinical effect of three adjacent skin flaps in repairing postoperative skin defect caused after head and facial tumor resection. Methods A consecutive series of 35 patients, in whom the rhomboid flap(n=15), H flap(n=8) and A-T flap(n=12) reconstruction were performed, was reviewed retrospectively, and the results were studied. Results In most patients, the results were satisfactory with excellent cosmetics and function. There were no complications such as infection and necrosis and no recurrence and metastasis in all cases. Two patients had the injury of frontal branch of facial nerve and two had the eye deformation. The scar in the rhomboid flap group had smoother surface as compared with the H flap and A-T flap groups and the statistical difference was significant (P＜0.05). Conclusion The adjacent skin flap has the characteristics of excellent cosmetics and function, making it an excellent choice of reconstruction of head and facial skin defect. There are different distinguishing features in the above-mentioned flaps and we should apply according to the actual situation.