小腿和足部恶性黑色素瘤术后皮肤缺损修复58例

目的探讨小腿内侧皮瓣和游离植皮修复小腿和足部恶性黑色素瘤术后皮肤缺损的临床疗效。方法对2000年1月至2011年11月使用小腿内侧皮瓣植皮和游离植皮修复小腿和足部恶性黑色素瘤术后缺损的58例病例,按照缺损部位、面积大小、手术方法、治疗结果等进行比较。其中小腿内侧皮瓣植皮23例,游离植皮35例。结果 58例患者术后切缘均为阴性,全部患者进行了6个月至5年的随访,平均随访29个月。小腿内侧皮瓣植皮23例中,存活21例,坏死1例,部分坏死1例,成活率91.3%,肢体功能恢复正常,创面无复发。游离植皮35例,存活17例,坏死8例,部分坏死10例,成活率48.6%,肢体功能较差,创面复发2例,后均行截肢手术。小腿内侧皮瓣植皮存活率明显高于游离植皮,差异有统计学意义(P<0.05)。结论小腿内侧皮瓣是修复小腿和足部恶性黑色素瘤术后缺损的有效方式之一。

Skin defect:repairing in 58 lower leg and foot malignant melanoma

Objective Explore the medial leg flap and skin graft on the clinical efficacy of malignant melanoma of skin defects after repair of the lower leg and foot.Methods From January 2000 to November 2011,58 cases of postoperative defect using the medial leg flap graft and skin graft to repair the leg and foot malignant melanoma.Compare of the defect,size,surgical methods,the treatment results.Medial leg flap of skin graft in 23 cases,35 cases of free skin grafting.Results 58 cases of postoperative margins were negative.58 cases were followed up for 6 months to 5 years,with average being 29 months.In 23 cases of medial leg flap,21 cases of survival,necrosis in 1 case,partial necrosis in 1 case,the survival rate of 91.3%.Limb function returned to normal.Wounds healed without recurrence.In 35 cases of free skin grafting,17 cases were survival,necrosis was occurred in 8 cases,partial necrosis occurred in 10 cases,the survival rate was 48.6%.Limb function is poor.Wound recurrence of 2 cases.2 cases of amputation.Medial leg flap graft survival rate was significantly higher than that in the free skin graft(P<0.05).Conclusion Medial leg flap is one of the best way to repair the leg and foot of malignant melanoma in postoperative defect.