邻近组织瓣即刻修复老年人侧面部肿瘤切除后软组织大面积缺损策略探讨  

The clinical strategy to immediately repair large facial defects of soft tissues by using adjacent tissue flaps after lateral facial skin malignant tumor resection in the elderly

作　　者：石亮[1] 许辉[2] 卡米力江·买买提明[2] 闫广鹏[2] 李军[2] Shi Liang;Xu Hui;Kamilijiang·Maimaitiming;Yan Guangpeng;Li Jun(Department of Oral and Maxillofacial Surgery,Shandong University Qilu Hospital,Jinan 250012,China;Department of Oral and Maxillofacial Surgery,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]山东大学齐鲁医院口腔颌面外科,济南250012 [2]新疆维吾尔自治区人民医院口腔颌面外科,乌鲁木齐830001

出　　处：《中华整形外科杂志》2021年第8期847-855,共9页Chinese Journal of Plastic Surgery

基　　金：山东省重点研发计划项目(GG201709220011);新疆维吾尔自治区区域协同创新专项基金(2020E0284)。

摘　　要：目的探讨邻近组织瓣同期修复老年患者侧面部皮肤恶性肿瘤切除后软组织大面积缺损的临床修复策略。方法回顾性分析2016年7月至2020年6月,山东大学齐鲁医院口腔颌面外科、新疆维吾尔自治区人民医院口腔颌面外科收治的行手术治疗的老年侧面部皮肤恶性肿瘤患者的临床资料。肿瘤切除后软组织缺损面积均≥3.0 cm×3.0 cm。以耳轮最高点至外眦连线为解剖标记线,标记线下为Ⅰ型缺损,标记线以上为Ⅱ型缺损。将Ⅰ型缺损分为2个亚型:Ⅰa型,缺损主要位于颊区美学单位区,采用颏下动脉岛状皮瓣(SMAIF)修复,恢复其厚度以及外形凸度;Ⅰb型,缺损直接延及耳屏前,耳屏与缺损之间无皮肤及组织保留,位于侧区以及颧区美学单位区,缺损组织较薄弱,采用颈胸旋转皮瓣或侧面颈旋转皮瓣修复。Ⅱ型缺损采用颈胸旋转皮瓣+额部旋转皮瓣进行修复。应用视觉模拟量表(VAS)评价术后3个月时患者对切口设计及美观效果的满意程度。结果研究共纳入24例患者,男15例,女9例,发病时的平均年龄为68.6岁(57~86岁),其中男性69.7岁,女性66.8岁。肿瘤切除后缺损面积平均37.1 cm^(2)(5.0 cm×4.5 cm~8.5 cm×7.0 cm)。Ⅰa型缺损6例,采用SMAIF修复;Ⅰb型缺损6例,采用颈胸旋转皮瓣修复3例、侧面颈旋转皮瓣修复3例;Ⅱ型缺损12例,采用颈胸旋转皮瓣+额部旋转皮瓣修复。随访10~43个月,平均27.1个月,VAS评分平均为9.3分(8.9~9.7分),患者对切口设计及手术整体效果均表示非常满意,无肿瘤复发。结论以耳轮最高点至外眦连线作为解剖标记,将侧面部软组织大面积缺损依据分区以及解剖特点分别设计SMAIF、颈胸旋转皮瓣、侧面颈旋转皮瓣、额部旋转皮瓣中1种或多种邻近组织瓣进行即刻修复,可考虑作为老年面部皮肤恶性肿瘤切除术后缺损修复的诊疗策略。Objective To explore the clinical strategy of using adjacent tissue flaps to immediately repair large facial soft tissue defects after resection of lateral facial skin tumors in the elderly patients.Methods The clinical data of the elderly patients with large soft tissue defects after resection of skin malignant tumors on the lateral facial region from July 2016 to June 2020 were reviewed by the Department of oral and maxillofacial surgery of Qilu Hospital of Shandong University and the Department of Oral and Maxillofacial Surgery of Xinjiang Uygur Autonomous Region People’s Hospital.All the soft tissue defects after tumor resection were larger than 3.0 cm×3.0 cm.The line drawn from the top of the helix to the lateral canthus was used as an anatomical marker.Twelve cases of typeⅠdefects were located in the lower part,and 12 cases of typeⅡdefects were located in the upper part.TypeⅠcould be subdivided into two subclasses:TypeⅠa,which was mainly located in the aesthetic unit of the buccal area.Submental artery island flap(SMAIF)was used to repair and restore its thickness and convexity.TypeⅠb,the defects extended directly to the tragus,which was located in the aesthetic regions of the lateral and zygomatic subunits,cervicofacial or cervicothoracic rotation flaps were used to repair thinner tissue defects.For typeⅡ,defects mainly located in the temporal and forehead regions abovethe dividing line,which were repaired by the cervicothoracic and forehead rotation flaps.Then,visual analogue scale(VAS)was used to evaluate patients’satisfaction about the incision design and aesthetic outcome 3 months after operation.Results There were 24 patients(15 males and 9 females)included in this study with an average age of 68.6 years(range from 57-86 years)when the disease was at onset,including 69.7 years for males and 66.8 years for females.The average defect area after tumor resection was 37.1 cm^(2)(5.0 cm×4.5 cm-8.5 cm×7.0 cm).Six cases of typeⅠa defect were repaired with SMAIFs.Three cases of typeⅠb de

关 键 词：老年人 皮肤肿瘤 面部 外科皮瓣 

分 类 号：R739.91[医药卫生—肿瘤]