会阴肿瘤切除术后缺损之皮瓣/肌皮瓣修复方法的选择和效果  

Selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection

作　　者：宋达疆[1] 李赞[1] 周晓[1] 章一新[2] 彭小伟[1] 冯光[3] 周波[1] 吕春柳[1] 伍鹏 唐园园 彭文[1] 毛煌兴 柳泽洋 韩惟青[4] 陈亦乐[5] 唐迪红[5] 周彦杰[5] 张克强[5] Song Dajiang;Li Zan;Zhou Xiao;Zhang Yixin;Peng Xiaowei;Feng Guang;Zhou Bo;Lyu Chunliu;Wu Peng;Tang Yuanyuan;Peng Wen;Mao Huangxing;Liu Zeyang;Han Weiqing;Chen Yile;Tang Dihong;Zhou Yanjie;Zhang Keqiang(Department of Oncology Plastic Surgery,Hunan Cancer Hospital,Changsha 410008,China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Burns and Plastic Surgery,the Fourth Medical Center of PLA General Hospital,Beijing 100048,China;Department of Urology Surgery,Hunan Cancer Hospital,Changsha 410008,China;Department of Gynecologic Oncology,Hunan Cancer Hospital,Changsha 410008,China)

机构地区：[1]湖南省肿瘤医院肿瘤整形外科,长沙410008 [2]上海交通大学医学院附属第九人民医院整复外科,200011 [3]解放军总医院第四医学中心烧伤整形科,北京100048 [4]湖南省肿瘤医院泌尿外科,长沙410008 [5]湖南省肿瘤医院妇瘤科,长沙410008

出　　处：《中华烧伤杂志》2020年第6期451-457,共7页Chinese Journal of Burns

基　　金：湖南省自然科学基金面上项目(2018JJ2241、2018JJ2242);湖南省肿瘤整形外科临床医学研究中心平台建设专项(2013TP4087);湖南省科卫联合项目(2018JJ6028);湖南省卫生健康委员会课题(B2019092);长沙市科技计划基础研究项目(kq1901074、kq1901077)。

摘　　要：目的探讨会阴肿瘤切除术后缺损之皮瓣/肌皮瓣修复方法的选择和效果。方法2011年1月-2017年2月,湖南省肿瘤医院收治31例会阴肿瘤患者,采用多种形式皮瓣/肌皮瓣修复肿瘤切除后创面。患者中男5例、女26例,年龄39~76岁,原发病因中外阴癌27例、Paget病4例。会阴肿瘤根治性切除后继发缺损面积为8.0 cm×4.5 cm^27.5 cm×24.0 cm。结合缺损所在具体会阴及腹股沟区域及面积,并根据穿支体区理论,采用阴部外动脉穿支皮瓣、腹壁下动脉穿支皮瓣、腹直肌肌皮瓣、股前外侧皮瓣、阴部内动脉穿支皮瓣、股薄肌肌皮瓣和股深动脉穿支皮瓣等修复。根据皮瓣血运范围划分,总共切取17个局部转位皮瓣、18个轴型皮瓣/肌皮瓣、7个V-Y推进皮瓣,面积为7.0 cm×4.0 cm^21.0 cm×13.0 cm。皮瓣/肌皮瓣均带蒂转移,供区均无张力直接缝合。观察并记录皮瓣/肌皮瓣个数、创面闭合情况、皮瓣/肌皮瓣成活情况及随访情况。结果31例患者共切取42个皮瓣/肌皮瓣,其中11例患者采用2个皮瓣/肌皮瓣修复环周大面积缺损。所有缺损均达到无张力直接闭合。32个皮瓣/肌皮瓣术后血运良好,另外10个皮瓣/肌皮瓣血运不良。17个皮瓣/肌皮瓣术后存活良好;5个皮瓣/肌皮瓣术后8~14 d伤口裂开,经换药治疗后好转;7个皮瓣/肌皮瓣术后2~5 d出现暂时性充血,未予特殊处理后逐渐恢复;3个皮瓣/肌皮瓣术后7~15 d发生感染,经换药治疗后2个皮瓣好转,另外1个皮瓣/肌皮瓣因部分坏死行清创后直接拉拢缝合;2个皮瓣/肌皮瓣术后8~15 d完全坏死,均于清创后采用带蒂腹直肌肌皮瓣修复;7个皮瓣/肌皮瓣术后7~20 d部分坏死,经换药治疗后愈合。24例患者获随访,时间9~38个月,皮瓣/肌皮瓣色泽与周围皮肤相近,外阴外形较佳,髋关节活动未见受限,排尿、排便功能未受影响,其中3例患者肿瘤复发。结论对会阴肿瘤切除术后复杂大面积缺损,根�Objective To explore the selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection.Methods From January 2011 to February 2017,31 patients with vulvar tumor who were admitted to Hunan Cancer Hospital underwent repair of wound after tumor resection with various flaps/myocutaneous flaps.The patients were composed of 5 males and 26 females,aged 39-76 years,with 27 vulvar cancer and 4 Paget′s disease in primary diseases.The size of defects after vulvar tumor radical resection ranged from 8.0 cm×4.5 cm to 27.5 cm×24.0 cm.According to the theory of perforasome,the defects were repaired by the external pudendal artery perforator flap,deep inferior epigastric artery perforator flap,rectus abdominis myocutaneous flap,anterolateral thigh flap,internal pudendal artery perforator flap,gracilis myocutaneous flap,and profunda artery perforator flap based on the specific size and location of perineum and groin where the defect was located.According to the blood supply zone of flap,totally 17 local translocation flaps,18 axial flaps/myocutaneous flaps,and 7 V-Y advancement flaps were resected,with an area of 7.0 cm×4.0 cm to 21.0 cm×13.0 cm.All the flaps/myocutaneous flaps were transferred in pedicled fashion,and the donor sites were closed without tension.The number of flaps/myocutaneous flaps,wound closure,flaps/myocutaneous flaps survival,and follow-up were observed and recorded.Results Altogether 42 flaps/myocutaneous flaps were harvested in 31 patients.Two flaps/myocutaneous flaps were used in 11 cases for large circular defect repair.All the defects achieved tension-free primary closure.The blood supply of 32 flaps/myocutaneous flaps was good,while insufficient blood supply was noted in the other 10 flaps/myocutaneous flaps.Seventeen flaps/myocutaneous flaps survived smoothly.Wound dehiscence occurred in 5 flaps/myocutaneous flaps 8 to 14 days postoperatively,which was healed with dressing change.Temporary congestion was noted in 7 flaps/myocutaneous flaps 2 to 5 days

关 键 词：外阴肿瘤 创伤和损伤 外科皮瓣 治疗效果 

分 类 号：R644[医药卫生—外科学] R49[医药卫生—临床医学]