自由式穿支皮瓣在鼻肿瘤切除后缺损修复中的应用  

Application of free-style perforator flap to repair nasal defect after tumor resection

作　　者：余道江[1] 赵天兰[1] 孙卫[1] 韩文雅[1] 伍丽君[1] 于文渊[1] 洪嘉昀 王晓云[1] 曹世坤 蔡卫超 Yu Daojiang;Zhao Tianlan;Sun Wei;Han Wenya;Wu Lijun;Yu Wenyuan;Hong Jiayun;Wang Xiaoyun;Cao Shikun;Cai Weichao(Department of Plastic Surgery,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院整形外科,215004

出　　处：《中华医学美学美容杂志》2018年第4期223-226,共4页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：国家自然科学基金资助项目（81703157）;苏州市科技指导计划项目（SYSD2015092）;江苏省青年医学重点人才项目（QNRC2016860）

摘　　要：目的探讨自由式穿支皮瓣在鼻肿瘤切除后缺损修复中的应用价值。方法依据术前多普勒检测结果，设计以自由式穿支血管为蒂的v_Y推进皮瓣等多种皮瓣，转移修复鼻肿瘤切除后创面。术后1个月，根据病理结果行放疗，评价复发率。结果31例患者皮瓣全部成活，29例伤口一期愈合。1例术后出血，皮瓣张力较大、表皮形成水疱，抽出疱液、经换药愈合。1例静脉回流不畅，皮瓣瘀血，针刺放血处理后，延迟愈合。23例术后行辅助放射治疗，随访6个月至5年，修复后局部外形及色泽均满意，肿瘤无复发。结论自由式穿支皮瓣修复鼻肿瘤扩大切除后创面，既利于肿瘤术后及时有效放疗，又有较好的外观。Objective To study the value of free-style perforator flap in repairing nasal defects after tumor resection. Methods On the basis of the guidance of free-style perforator flap design concept and the foundation of vascular localization by Doppler based on the ultrasonic echo intensity, combined with nasal beauty subunits, we designed free-style perforator flap in different forms such as V-Y advancing flap, rotating flap, and propeller flap, which had with free-style perforator in pedicle all. We transplanted the flaps to repair nasal defects after tumor resection. The area of the flaps was be- tween 2 cm x 1.0 cm and 8.0 cm x 5.0 cm, and the diameter of the perforate vessel in the pedicle of flap was between 0.3 mm-3 mm, and some of the pedicles were composed of perforate vessel tube bundle. In order to reduce recurrence rate, the radiotherapy was performed according to the pathology in 1 month after surgery. Results In 31 cases of this group, 29 cases were performed and the postop- erative shape was good. 1 case appeared postoperative hemorrhage, and the epidermis of flap formed blister because of greater tension, and the patient healed 10 days later after extraction the bubble fluid and changing medicine. The flap of 1 case was silted because the venous was blocked, and the acu- puncture was treated, and then the flap got delayed union. 23 cases received adjuvant radio therapy af- ter surgery and fellowed up from 6 months to 5 years, showing that local profile and color were sati- sfacfory without tumor recurrence. Conclusions It is worthy of clinical promotion to designing free- type perforator flap and to repair defect after extensive nasal tumor resection on the basis of beauty subunits in nasal and vascular anatomy, which can not only reduce the recurrence rate by postoperative radiotherapy in time, but also realize better cosmetic requirements.

关 键 词：鼻肿瘤 修复 皮瓣 自由式穿支皮瓣 

分 类 号：R739.62[医药卫生—肿瘤] R622[医药卫生—临床医学]