各种穿支皮瓣修复足底黑色素瘤广泛切除术后缺损的优缺点分析  

Analysis of Advantages and Disadvantages of Perforator Flap in Repairing Defects of Plantar Melanoma After Extensive Resection

作　　者：李进[1] 许祺琨[1] 徐学峰[1] 杜永军[1] LI Jin;XU Qi-kun;XU Xue-feng(The First People’s Hospital of Foshan,Foshan,Guangdong,528000,China)

机构地区：[1]佛山市第一人民医院,广东佛山528000

出　　处：《黑龙江医学》2020年第8期1024-1027,共4页Heilongjiang Medical Journal

摘　　要：目的分析各种穿支皮瓣修复足底黑色素瘤广泛切除术后缺损的优缺点。方法选取佛山市第一人民医院整形美容二科2018年1月—2019年7月收治的15例足底黑色素瘤患者,进行肿瘤细胞起始位置广泛切除术后分别行足底内侧皮瓣移位修复术、动脉逆行岛状皮瓣修复、外踝上穿支皮瓣修复足踝部软组织缺损、内踝上穿支皮瓣修复足踝部软组织缺损及股前外侧游离皮瓣移植颊再造术,对行各种穿支皮瓣修复术患者的病历资料和跟踪随访结果进行分析。结果6例行足底内侧皮瓣移位修复术全部存活。1例行逆行岛状皮瓣联合局部皮瓣修复出现部分坏死,缝合伤口在愈合过程中发生炎症感染,或出血、液化等并发症,致使切口裂开,经一段时间积极治疗后,将裂开的伤口再次缝合而痊愈。2例外踝和内踝上穿支皮瓣修复足踝部软组织缺损全部存活。2例行游离股前外侧皮瓣修复,1例存活,1例皮瓣发生部分远端糜烂,换药后愈合。所有病例无基于其他原发病,患侧足均可正常行走,无痛感。2例行足底内侧皮瓣移位修复术后发生局部复发。结论各种穿支皮瓣修复足底黑色素瘤术后缺损均疗效显著,对足根部较小缺损(<8 cm)首选足底内侧皮瓣移位修复术,较大缺损可采用内外踝上穿支皮瓣修复足踝部皮肤缺损,有显微外科手术工作条件的可行游离股前外侧皮瓣修复局部皮瓣无法覆盖的缺损。Objective To analyze the advantages and disadvantages of perforator flap in repairing defects after extensive plantar melanoma resection.Methods Selecting 15 patients with plantar melanoma in the Second Department of Plastic Surgery of the hospital from January,2018 to July,2019.Tumor cells after extensive resection received separately plantar medial flap translocation prosthesis,artery retrograde island flap to repair,external ankle on wear of skin flap to repair the soft tissue defect in ankle,perforators of skin flap to repair the soft tissue defect in ankle on the medial malleolus and femoral anterolateral buccal repair.Free flap transplantation in patients with line of perforators flap repair of medical records and follow-up results were analyzed.Results 6 cases of medial plantar flap transposition all survived.1 case of retrograde island flap combined with local flap was used to repair partial necrosis,and the wound was closed with inflammatory infection or bleeding,liquefaction and other complications during the healing process,resulting in incision split.After a period of active treatment,the split wound was sewn up again and healed.The upper perforator flap of ankle and medial malleolus was used to repair the soft tissue defect of foot and ankle.2 cases were repaired by free anterolateral thigh flap,1 case survived,1 case suffered from partial distal erosion,and healed after dressing change.All cases were not based on other primary diseases,and the affected lateral foot could walk normally without pain.2 cases of local recurrence occurred after transposition of medial plantar flap.Conclusion Curative effect Postoperative defect of perforators flap to repair a foot melanoma is obvious.Plantar medial flap translocation prosthesis is primarily fit for the foot root small defect(<8 cm).Larger defect can be used in external ankle on the perforators of skin flap to repair the skin defect of ankle.If there is microsurgical operation condition,feasible free femoral anterolateral skin flap can be used to repair t

关 键 词：穿支皮瓣 足底黑色素瘤 广泛切除术 缺损 

分 类 号：R62[医药卫生—整形外科]