足底内侧皮瓣与腓肠神经逆行筋膜皮瓣修复足跟部黑色素瘤切除后的皮肤缺损  

Reparation with medial plantar flap and reverse sural fasciocutaneous flap after resection of melanoma on the heel

作　　者：刘佳勇[1] 樊征夫[1] 方志伟[1] 白楚杰[1] 薛瑞峰[1] 李舒[1] 张路[1] 高天[1] 谭智超 LIU Jiayong;FAN Zhengfu;FANG Zhiwei;BAI Chujie;XUE Ruifeng;LI Shu;ZHANG Lu;GAO Tian;TAN Zhichao(Department of Orthopedic Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所,骨与软组织肿瘤科,北京100142

出　　处：《中国肿瘤外科杂志》2020年第2期112-116,共5页Chinese Journal of Surgical Oncology

摘　　要：目的研究采用足底内侧皮瓣和腓肠神经逆行筋膜皮瓣修复足跟部黑色素瘤切除后皮肤缺损的治疗效果。方法回顾性分析2008年9月至2018年12月间北京大学肿瘤医院收治的足跟恶性黑色素瘤的临床资料,在原发灶局部广泛切除后分别采用足底内侧皮瓣(A组)或腓肠神经逆行筋膜皮瓣(B组)进行修复。统计分析患者的生存情况,同时比较两种皮瓣在修复范围、坏死率、感觉恢复及溃疡率等方面的差异。结果共87例。A组25例,平均缺损长径为(6.1±1.4)cm,其中1例(4.0%)发生皮瓣坏死;B组62例,平均缺损长径为(7.5±2.4)cm,其中5例(8.1%)发生皮瓣坏死。A组的皮瓣感觉恢复要明显优于B组(P<0.001);A组无皮瓣发生溃疡,B组16例(25.8%)发生溃疡,两组间差异有统计学意义(P=0.004)。总体中位无病生存时间为66.5个月(55.1~78.0个月);中位总生存时间为80.9个月(69.3~92.5个月)。AJCC分期是影响无病生存时间(P<0.001)和总生存时间(P=0.006)的唯一因素。结论早中期足跟部恶性黑素瘤的预后较好,应尽量采用局部带蒂皮瓣进行修复。足底内侧皮瓣术后的外形美观,感觉恢复更好,发生远期溃疡的风险低,是首选的修复方法;腓肠神经逆行筋膜皮瓣则更适合于缺损范围较大或偏足跟外侧的病灶。Objective To study the effect of medial plantar flap(MPF)and reverse sural fasciocutaneous flap(RSFF)in reparation of the skin defect after resection of melanoma on the heel.Methods A retrospective analysis was performed on malignant melanoma on the heel between September 2008 and December 2018 in Peking University Cancer Hospital.After wide resection of the primary lesions,MPF(group A)and RSFF(group B)were used for reparation.The survival of the patients was analyzed,and the differences between the two flaps in size of defection,necrosis rate,sensory recovery and ulceration rate were compared.Results In group A,25 patients received MPF with a mean length of defection of(6.1±1.4)cm,and necrosis occurred in 1 case(4.0%).In group B,62 cases received RSFF with a mean length of defection of(7.5±2.4)cm,and 5 cases(8.1%)had necrosis.Sensory recovery of flaps in group A was significantly better than that in group B(P<0.001).No ulceration occurred in group A and 16 cases(25.8%)occurred in group B(P=0.004).The total median disease-free survival(DFS)time was 66.5 months(55.1-78.0 months)and the median overall survival(OS)time was 80.9 months(69.3-92.5 months).AJCC was the only factor that affected both DFS(P<0.001)and OS(P=0.006).Conclusions Local pedicle flaps should be used for reparation after resection of early stage melanoma patients on the heel,according to their favorable prognosis.Medial plantar flap is the preferred recommendation for its better results in appearance,sensory recovery and ulceration rate.While reverse sural nerve fasciocutaneous flap is more applicable in cases with large defection or lateral side lesions.

关 键 词：恶性黑色素瘤 足跟 足底内侧皮瓣 腓肠神经逆行筋膜皮瓣 

分 类 号：R73[医药卫生—肿瘤]