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瘢痕癌的整形外科治疗与预防 总被引:1,自引:0,他引:1
目的 观察整形外科修复治疗不同类型、不同部位的瘢痕癌临床效果。方法 根据 2 7例不同类型瘢痕癌的恶性程度和不同部位 ,拟定扩大切除范围和深度 ,局部皮肤及软组织缺损创面 ,采用邻近带有知名血管蒂或无名血管蒂的筋膜皮瓣修复辅以中厚皮片游离移植 ,若局部皮肤及软组织缺损创面较大者 ,采用单纯厚中厚皮片游离移植修复。结果 术后 8年无复发 19例 ,4~ 5年复发再手术后 5年无复发 4例 ,多次复发再手术生存 5年以上 2例 ,死于广泛转移 2例。结论 应用不同的整复方法修复不同部位的皮肤及软组织缺损 ,是降低瘢痕癌复发率 ,提高生存率的有效措施之一 ,同时注重深度烧伤的早期治疗和严重瘢痕挛缩的早期整复治疗 ,更是降低瘢痕癌发生率的关键。 相似文献
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瘢痕癌的整形外科治疗与预防 总被引:1,自引:0,他引:1
目的 观察整形外科修复治疗不同类型,不同部位的瘢痕癌临床效果。方法 根据27例不同类型瘢痕癌的恶性程度和不同部位,拟定扩大切除范围和浓度,局部皮肤及软组织缺损创面,采用邻近带有知名血管蒂或无名血管蒂的筋膜皮瓣修复辅以中厚皮片游离移植,若局部皮肤及软组织缺损创面较大,采用单纯厚中厚皮片游离移植修复,结果 术后8年无复发19例,4-5年复发再手术后5年无复发4例,多次复发再手术生存5年以上2例,死于广泛转移2例。结论 应用不同的整复方法修复不同部位的皮肤及软组织缺损,是降低瘢痕癌复发率,提高生存率的有效措施之一。同时注重深度烧伤的早期治疗和严重瘢痕挛缩的早期整复治疗,更是降低瘢痕癌发生率的关键。 相似文献
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青少年皮肤恶性肿瘤的治疗 总被引:2,自引:0,他引:2
目的:总结青少年皮肤恶性肿瘤的治疗经验。方法:分析1991年2月~2003年9月间,收治13例青少年皮肤恶性肿瘤的临床资料,采用病灶彻底切除、皮瓣转移或全厚皮片移植修复术,辅以放射、化学或免疫等方法治疗,对其治疗效果与随访结果进行总结。结果:鳞状细胞癌6例、基底细胞癌2例、恶性黑色素瘤4例和血管内皮肉瘤1例,是本组病例的主要类型,术后随访2~8年,随访12例,失访1例。局部复发与淋巴结转移3例,截肢(指)2例,死亡2例,其余术区外形和功能恢复良好。结论:彻底切除病灶是皮肤肿瘤治疗取得良好疗效的关键,皮瓣、皮片修复有助于术区外形和功能的恢复。放射、化学和免疫等辅助治疗是预防术后复发的有效方法。 相似文献
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目的探讨四肢骨骼、肌肉系统肿瘤切除后软组织缺损的修复。方法对1992年~2004年收治的骨肿瘤23例(以局部活检、局部复发污染较重及局部曾行放疗软组织条件较差为主)行肿瘤切除,所遗软组织缺损:病变位于小腿上段者行腓肠肌内侧头肌瓣转移并游离植皮18例,5例病灶位于小腿下段者予吻合血管的皮瓣或肌皮瓣修复。软组织肿瘤切除后皮肤缺损15例,均行游离皮瓣或肌皮瓣修复。结果转移肌瓣并游离植皮及吻合血管的皮瓣或肌皮瓣全部成活。结论胫骨上段肿瘤彻底切除后所遗软组织缺损,以转移腓肠肌内侧头肌瓣并以中厚皮片游离植皮修复,方法简单、可靠;其它部位骨骼、肌肉系统肿瘤彻底切除后所遗软组织缺损,以吻合血管的腹直肌或胸脐皮瓣修复较理想,但要求有好的显微外科技术。 相似文献
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目的 探讨手术治疗足跟与足跖部部皮肤恶性黑色素瘤的适宜方式。方法 对 1 994年以来收治的 1 2例足跟与足跖部皮肤恶性黑色素瘤患者在病灶彻底切除后 ,7例患者采用岛状皮瓣转移修复创面 ,5例患者采用全厚皮片移植修复创面。对其临床资料与随访结果进行回顾性总结和分析。结果 皮瓣修复组获得随访的 6例患者均存活 ,术区外形和功能恢复良好 ,局部无复发 ;皮片修复组 4例患者获得随访 ,其中 2例死亡 ,1例局部复发 ,1例发生全身转移 ,另外 2例存活 ,术区外形和功能尚满意。结论 在一定的广度和深度彻底切除足跟与足跖部皮肤恶性黑色素瘤是取得良好疗效的关键 ,其中切除深度更重要。 相似文献
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目的 探讨治疗面部皮肤恶性黑色素瘤切除后皮肤缺损的手术方法 ,并评价其临床疗效。方法 2007年2月至2014年3月本科收治9例面部皮肤恶性黑色素瘤,均采用手术扩大切除病灶;术中常规冰冻切片监测手术切缘,病灶切除后皮肤软组织缺损,分别采用游离皮片移植2例,邻近任意皮瓣6例,游离皮瓣1例,术后常规辅以免疫治疗。结果 9例皮片及皮瓣均成活,伤口Ⅰ期愈合。局部形态较好,术区平整,瘢痕不明显。9例患者获随访3个月~7年,死亡2例,其中1例因其他疾病术后2年死亡;其余病例外形良好,未见局部复发。结论 面部皮肤恶性黑色素瘤手术治疗联合术后辅助免疫治疗疗效肯定,皮瓣修复可取得较为理想的局部外形,术中常规冰冻切片是保证肿瘤根治的一项重要手段。 相似文献
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目的探讨采用手术联合免疫疗法治疗皮肤恶性黑色素瘤的临床疗效。方法1998年8月-2010年12月,对收治的34例皮肤MM患者按照无瘤技术在一定深度与广度完整切除肿瘤病灶,根据创面部位、大小、深度,遵照“宁近勿远,宁简勿繁”的原则,分别选择皮瓣或皮片修复创面;术后按照“扶正驱邪”理论,选择免疫治疗做为辅助治疗,并按期随访。结果14例采用18个皮瓣修复,皮瓣均100%成活,术区外形与功能良好;13例于术后7~132月得到随访,9例存活,4例死亡;存活者中最长1例已无瘤健康存活11年。18例皮片修复者中,7例皮片存活率为95%左右,经换药愈合;其余11例皮片成活率均为100%,术区外形与功能均良好;15例术后12~120月随访结果显示,9例存活,6例死亡。2例分别行掌指/跖趾关节离断术者,伤口一期愈合,现分别为手术后15月与24月,全身情况良好,局部无任何复发迹象。结论手术联合免疫治疗是目前治疗皮肤恶性黑色素瘤的良好方法。 相似文献
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目的:比较足底部皮肤恶性黑色素瘤切除术后两种修复方法的疗效。方法:回顾性分析2006年7月~2014年2月我院收治31例足底部皮肤恶性黑色素瘤患者临床病理资料,其中男14例,女17例。临床分期:I期2例,Ⅱ期9例,Ⅲ期20例。手术均行距肿瘤边缘2cm的广泛切除+腹股沟淋巴结清扫术;足底肿瘤切除术后缺损以两种方式修复,A组(11例):直接从同侧腹股沟切口取全厚皮片修复或皮瓣修复+取同侧腹股沟全厚皮片修复供皮瓣区。 B组(20例):直接取同侧大腿中厚皮片植皮修复或皮瓣修复+取同侧大腿中厚皮片修复供皮瓣区;比较两组患者的手术时间、术中出血量、术中淋巴结清扫数目、住院时间、住院费用、腹股沟伤口并发症及足底局部复发情况等方面的差异。结果:术后足底缺损区植皮或皮瓣完全成活,肿瘤均无局部复发。两种方法在住院时间、住院费用及腹股沟伤口术后并发症方面差异有统计学意义(p0.05)。结论:与从同侧大腿取中厚皮片修复相比,从腹股沟切口直接取全厚皮片修复减少手术伤口,并发症少,住院时间短,住院费用低,是一种较理想的修复方法。 相似文献
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The value of various surgical techniques used to reconstruct full-thickness cheek defects is discussed. Small defects can be repaired with the use of local cervical skin flaps with a random vascular pattern. Axial pattern temporal flap is another choice, either alone or combined with a cervical flap. Whenever local tissues are not suitable (i.e. after irradiation or neck dissection) a transfer of distant myocutaneous island flap based on a pedicle of axial muscle vessels is a valuable alternative. Split skin graft may form a good intra-oral lining of such island flap. 相似文献
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AIM: The aim of this study was to salvage or to integrate exposed alloplastic meshes in post malignancy irradiated chronic wounds by using topical negative pressure (TNP) therapy together with staged debridement. METHODS: Three patients with secondarily exposed alloplastic meshes in irradiated non-healing wounds were treated by serial debridement and repeated topical negative pressure therapy until clean and vital wounds were achieved, followed by ultimate plastic coverage by a myocutaneous flap or split-thickness skin graft. The range of the follow-up period was from 18 to 36 months. RESULTS: After staged serial debridement and repeated vacuum treatment periods wounds were preconditioned in an acceptable fashion for ultimate plastic coverage. After the treatment with a myocutaneous flap or split-thickness skin graft all three patients achieved long-term stable wounds with no alloplastic mesh complication within the follow-up period. CONCLUSION: Computer-controlled TNP therapy (vacuum-assisted closure therapy) together with staged debridement can help to induce granulation tissue formation in irradiated wounds and allows integration of alloplastic materials into regenerating wounds after ablative oncologic surgery. 相似文献
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Between 24 November 1977 and 16 September 1988, 18 consecutive chest wall resections for recurrent breast cancer after failure of radiotherapy, were evaluated as of 1 January 1990. Chest wall involvement was the only site of recurrence in 14 patients (Group I), and the most painful of the multiple recurrences in the remaining four (Group II). Of Group I, chest wall recurrence was local in eight patients (four with necrosis after radiotherapy), regional in four, and distant in two. Chest wall reconstruction was effected by contralateral breast flap in six, by random cutaneous flap in seven and by myocutaneous flap in the remaining five. Cosmetic results were better if both marlex mesh and myocutaneous flap were used. Of Group I, at surgical/pathological staging, one recurrence with sarcomatous findings, two multiple recurrences and residual cancer in all necrosed local recurrences were found: in three of these cases radionecrosis was prominent. Mortality was 0% and surgical morbidity 5%. For Group I, median disease-free interval from mastectomy was extended from 1611 days to 3220 by recurrence resection, and disease-free interval from chest wall resection was 28% cancer-free at 1657 days, without any difference between the local vs regional-distant recurrence. Correlation factor between first and second disease interval was 0.99 and R2 was 0.98. For Group II, survival was 0% at 635 days. Chest wall resection must be considered as an important part of palliative treatment in breast cancer, but the results reflects the biology of the disease more than the chest wall surgery. 相似文献
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Kunal Ranjan Vinay Venkataramu Hari Prasad Achanti Shruti Khemka Ashok Mohan Shenoy Mitali Dandekar 《Indian journal of otolaryngology and head and neck surgery》2021,73(1):129
Scalp is a common site for skin tumors mainly squamous cell carcinoma and basal cell carcinoma. It is always challenging to reconstruct the scalp defect following tumor excision. Conventional methods of skin grafting or rotation flap is not always feasible for large scalp defect. This paper presents the author’s experience in 3 patients of scalp tumors in which conventional methods were not sufficient to reconstruct the defect, hence pedicled latissimus dorsi flap was used considering the flap size to cover the defect and reach needed for the pedicled flap. In all the 3 cases latissimus dorsi myocutaneous was able to reach the defect site and cover the large scalp defect area; thereby serving as an alternative to free flap which is technically more challenging, skill based and less feasible in normal surgical settings. 相似文献