游离股前外侧Kiss皮瓣修复巨大头皮恶性肿瘤术后缺损  

Application of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection

作　　者：左良 喻建军 周晓 戴捷 田皞 单振锋 胡杰 谌星 王鸿涵 蔡旭 高水超 ZUO Liang;YU Jianjun;ZHOU Xiao;DAI Jie;TIAN Hao;SHAN Zhenfeng;HU Jie;CHEN Xing;WANG Honghan;CAI Xu;GAO Shuichao(The Second Department of Head and Neck Surgery, Department of Oncoplastic Surgery, Hunan Cancer Hospital ＆ the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, 410013, P.R. China)

机构地区：[1]湖南省肿瘤医院中南大学湘雅医学院附属肿瘤医院头颈外二科/肿瘤整形外科,长沙410013

出　　处：《中国修复重建外科杂志》2018年第3期346-349,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省科技计划资助项目(2013SK3205)~~

摘　　要：目的总结游离股前外侧Kiss皮瓣修复巨大头皮恶性肿瘤术后缺损的疗效。方法 2012年12月—2016年12月,收治巨大头皮恶性肿瘤患者18例。男16例,女2例;年龄43~62岁,平均52.6岁。鳞状细胞癌17例,隆突性纤维肉瘤1例。病程3个月~6年,中位时间22.1个月。术中彻底切除肿瘤后,头皮软组织缺损范围为15 cm×10 cm^17 cm×12 cm;2例颅骨受累者切除全层颅骨后,缺损面积分别为10 cm×8 cm、12 cm×10 cm。制备游离股前外侧Kiss皮瓣修复创面,皮瓣切取范围为15 cm×6 cm^20 cm×8 cm;钛网修复颅骨缺损。供区直接拉拢缝合。结果术后皮瓣顺利成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合。1例因局部复发侵犯颅内于术后5个月死亡,其余患者均无局部复发。患者均获随访,随访时间6个月~4年,平均26.6个月。术后皮瓣外观较满意,随访期内无破溃发生。供区切口遗留线性瘢痕,未遗留明显功能障碍。结论游离股前外侧Kiss皮瓣可修复巨大头皮恶性肿瘤切除术后缺损,同时供区能直接拉拢缝合,避免因植皮产生第2供区。Objective To investigate the effectiveness of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection. Methods Between December 2012 and December 2016,18 patients with large scalp defect after malignant tumor resection were treated. There were 16 males and 2 females with an average age of 52.6 years（range, 43-62 years）. There were 17 cases of squamous carcinoma and 1 case of dermatofibrilsarcoma protuberan.The size of scalp defect ranged from 15 cm×10 cm to 17 cm×12 cm after resection of tumors. The scalp defects were repaired with the free anterolateral thigh Kiss flap. And the size of flap ranged from 15 cm×6 cm to 20 cm×8 cm. The skull was completely resected in 2 cases, and repaired with Titanium mesh. The sizes of skull defects were 12 cm×10 cm and10 cm×8 cm. The donor site was sutured directly. Results Eighteen flaps survived with primary healing of wounds; and healing by first intention was obtained at the donor sites. One patient died because of intracranial metastasis at 5 months after operation, and no local recurrence occurred in the other 17 patients. The follow-up time ranged from 6 months to 4 years（mean, 26.6 months）. The results of both appearance and function were satisfactory, without ulceration during follow-up. No obvious scar was found at donor sites and no obvious impairment was observed after harvesting free anterolateral thigh flap. Conclusion Large scalp defects after malignant tumor resection can be effectively repaired by free anterolateral thigh Kiss flap. The donor site can be sutured directly, without skin grafting, thus avoiding the secondary donor site.

关 键 词：Kiss皮瓣 游离股前外侧皮瓣 头皮恶性肿瘤 创面修复 

分 类 号：R739.91[医药卫生—肿瘤]