局部皮瓣修复鼻部皮肤恶性小肿瘤术后缺损54例

目的 探讨鼻部下1/3皮肤恶性小肿瘤手术切除后皮肤软组织缺损的多种皮瓣修复方法和效果.方法 手术切除鼻部皮损,术中病理示无残癌组织后,根据鼻缺损的部位、大小、形状以及周围皮肤情况等我们选择双叶皮瓣、双侧旋转皮瓣、鼻唇沟皮瓣等方法进行皮肤软组织缺损的修复.结果 鼻部皮肤恶性小肿瘤54例,基底细胞癌39例占72.22%,鳞状细胞癌9例占16.67%,角化棘皮瘤6例占11.11%.切除后的缺损均位于鼻部下1/3,长径均未超过2.0 cm,术中修复缺损选择双叶皮瓣20例,双侧旋转皮瓣2例,鼻唇沟皮瓣32例,术后皮瓣全部成活,未见鼻部明显变形.随访5年未见复发.结论 局部双叶皮瓣、双侧旋转皮瓣、鼻唇沟皮瓣等修复鼻部下1/3长径未超过2.0 cm的皮肤恶性肿瘤切除后的皮肤软组织缺损,可以获得较满意效果.

Application of local flaps in repair of nasal defects after excision of small cutaneous malignant tumors

Objective To investigate the methods for repairing skin defects after excision of small cutaneous malignant tumors at the lower one third part of nose and their clinical effects.Methods Lesions of small cutaneous malignant tumors at lower one third part of the nose were removed in 54 patients.Intraoperative pathology was performed to confirm the absence of survival carcinoma tissues after resection.According to the site,size,shape and neighborous skin status of defects,bilobed flaps,two-side rotation flaps and nasolabial flaps were selected to repair nasal skin tissue defects.Results There were 39(72.22%) cases of basal cell carcinoma, 9(16.67%) squamous cell carcinoma, 6(11.11%) keratoacanthoma.Skin defects after tumor removal were situated at the lower one third part of nose in all cases with less than 2.0 cm in diameter.Bilobed flaps were used to repair skin defects in 20 cases.rotation flaps in 2 cases,and nasolabial flap in 32 cases.As a result,all flaps survived and no obvious deformation of nose was observed in these cases.No recurrence occurred in a 5-year follow-up.Conclusion A satisfactory repair of skin defects at the lower one third part of nose with a diameter of less than 2.0 cm is achieved with bilobed flaps,two-side rotation flaps and nasolabial flaps.