【开放获取】局部皮瓣联合修复鼻及鼻周Mohs显微外科手术后较大缺损11例效果分析

【摘要】 目的 探讨局部皮瓣联合应用修复鼻及鼻周非黑素瘤皮肤癌Mohs显微外科手术后较大缺损的效果及优势。方法 2018年3月至2020年11月，于河北医科大学第二医院皮肤科收集行Mohs显微外科切除术后应用局部皮瓣联合修复的11例鼻及鼻周非黑素瘤皮肤癌患者。 根据术后缺损部位及大小，遵循鼻亚单位美学原则设计皮瓣进行修复，对于直接缝合或单个局部皮瓣无法覆盖的较大缺损，联合应用风筝皮瓣、改良菱形皮瓣、鼻唇沟皮瓣、双叶皮瓣等局部皮瓣中2 ~ 3种皮瓣修复创面。结果 11例患者中，基底细胞癌10例，鳞状细胞癌1例，缺损面积2.0 cm × 2.3 cm～2.7 cm × 3.6 cm。经Mohs显微外科手术联合局部皮瓣修复后皮瓣均存活良好，未出现血运障碍，修复皮瓣质地、颜色、轮廓等与周围正常皮肤相近，缺损未见明显瘢痕。术后随访4 ~ 32个月，肿瘤无复发，患者对外观满意。结论 联合应用2 ~ 3种皮瓣修复鼻及鼻周非黑素瘤皮肤癌Mohs手术后的较大缺损，可保持鼻及鼻周正常形态结构和美学效果，达到满意的美容修复效果。

Efficacy of combined local flaps in repair of larger defects in the nasal and perinasal region after Mohs micrographic surgery in 11 cases

【Abstract】 Objective To investigate efficacy and advantages of combined local flaps in repairing large defects in patients with nasal and perinasal non-melanoma skin cancers after Mohs micrographic surgery. Methods From March 2018 to November 2020, 11 patients with nasal and perinasal non-melanoma skin cancers, who underwent Mohs micrographic surgery followed by repair with combined local flaps, were collected from Department of Dermatology, the Second Hospital of Hebei Medical University. According to the location and size of postoperative defects, flaps were designed based on the nasal aesthetic subunit principle. For large defects that could not be directly sutured or covered by a single local flap, 2 or 3 kinds of flaps could be applied in combination, such as kite flap, modified diamond flap, nasolabial skin flap, bilobed skin flap, etc. Results Among the 11 patients, 10 were diagnosed with basal cell carcinoma and 1 with squamous cell carcinoma, and the area of defects ranged from 2.0 cm × 2.3 cm to 2.7 cm × 3.6 cm. After Mohs micrographic surgery combined with local skin flap repair, all skin flaps survived well without blood supply obstruction, the texture, color and contour of the skin flaps were similar to those of the surrounding normal skin, and no obvious scars were formed. During the postoperative follow-up of 4 to 32 months, no recurrence of the tumors occurred, and the patients was satisfied with the appearance. Conclusion To repair large defects using combined skin flaps of 2 or 3 kinds after Mohs micrographic surgery in patients with nasal and perinasal non-melanoma skin cancers can maintain the normal nasal and perinasal morphological structure and aesthetic appearance, and yield a satisfactory cosmetic effect.