局部皮瓣在鼻部皮肤恶性肿瘤切除后创面修复中的临床应用

目的:探讨应用局部皮瓣在鼻部皮肤恶性肿瘤切除后修复创面缺损的方法和效果。方法:2012年1月到2014年1月收治的鼻部皮肤恶性肿瘤患者39例。其中基底细胞癌31例,鳞状细胞癌8例,所有患者病变局限且未发现转移证据。手术切除肿瘤后根据缺损的大小、形状、位置及周围皮肤情况设计局部皮瓣进行修复。皮瓣大小为0.8cm×1.0cm~4.5cm×5.0cm,其中菱形皮瓣9例,双叶瓣1例,V-Y皮瓣4例,O-Z皮瓣5例,鼻唇沟皮瓣15例,额鼻皮瓣4例,额瓣1例。结果:37例患者缺损区局部皮瓣修复后Ⅰ期愈合,2例患者切口感染,经抗炎治疗并加强换药后Ⅱ期愈合。供区均未形成继发性缺损,达到Ⅰ期愈合。全部患者术后随访8~20个月,恶性肿瘤均无复发。鼻部外形总体轮廓良好,移植皮瓣与周围皮肤在颜色、质地等方面匹配良好,达到满意的面部形态和整形美容效果。结论:鼻部恶性肿瘤切除后根据缺损创面的大小、位置、形状及周围皮肤情况选用合适的局部皮瓣进行修复,可以取得较好及稳定的整形美容效果。

Reconstruction of nose defect with local flap after cutaneous carcinoma excision

Objective To explore the efficacy and kind of local flap in reconstructing nasal defect after cutaneous carcinoma excision. Methods From January 2012 to January 2014, according to the size,shape, location of nasal defect and the conditions of surrounding skin, homologous local flap was selected to cover the nasal defect in 39 cases which nasal cutaneous carcinoma were removed. Among 39 cases, there were 31 cases basal cell carcinoma, 8 cases of squamous cell carcinoma. The clinical stage of malignant carcinoma was 0-1 stage. The area of the local flaps ranged between 0.8cm×0.1cm and 4.5cmx5.0cm. The origin of flaps were rhomboid flap in 9 cases, bilobed flap in 1 case, V-Y flap in 4 cases, O-Z flap in 5 cases, nasolabial flap in 15 cases, frontonasal flap in 4 cases, forehead flap in 1 cases. Results Among 39 cases, 37 cases acquired complete recovery; 2 cases which had suffered low-grade infection of incision achieved healing by the anti-infective treatment and regional change dressings. The nasal defect was successfully repaired in all patients, and the all flaps survived. A total of 39 patients were available for follow-up of 8 to 20 months, no carcinoma recurrence occurred, and the repaired tissue were good match with surrounding tissue, good nasal contour was obtained, the cosmetic results were satisfactory. Conclusion According to the size, shape, location of nasal defect and the conditions of surrounding skin, homologous local flap can reconstruct the nose defect after cutaneous carcinoma excision and the cosmetic results are satisfactory.