胫后动脉穿支皮瓣修复下肢黑色素瘤及皮肤鳞状细胞癌术后缺损的临床效果  

Clinical effect of posterior tibial artery perforating flap in repairing postoperativedefects of lower extremity melanoma and cutaneous squamous cell carcinoma

作　　者：李林[1] 宋培军[1] 张莉[1] LI Lin;SONG Peijun;ZHANG Li(Department of Plastic Surgery,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233000,China)

机构地区：[1]蚌埠医学院第一附属医院整形外科,安徽蚌埠233000

出　　处：《重庆医学》2023年第18期2774-2779,共6页Chongqing medicine

基　　金：安徽省教育厅高等学校自然科学重点研究项目(KJ2019A0374)。

摘　　要：目的 研究胫后动脉穿支皮瓣在下肢黑色素瘤及皮肤鳞状细胞癌患者术后缺损修复中的临床效果。方法 选取2019年6月至2021年6月该院10例下肢黑色素瘤和10例下肢皮肤鳞状细胞癌患者作为研究对象,采用胫后动脉穿支皮瓣修复患者扩大切除术后导致的创面缺损。患者病灶面积为(2.0 cm×1.5 cm)~(9.0 cm×8.5 cm);皮瓣切取面积为(6.0 cm×5.0 cm)~(12.0 cm×9.0 cm)。术后辅助放射治疗5~8周,术后门诊随访记录皮瓣的外观、色泽、对下肢运动功能的影响及供皮区的预后情况。采用头颈部肿瘤患者生存质量测定量表(FACT-HN)评价患者的生活质量。结果 20例患者皮瓣均完全成活,术后门诊随访3~25个月,皮瓣外形良好,色泽正常,无破溃,供区及受区呈线性瘢痕,患肢运动正常。与术前比较,患者在生理状况领域(PWB)、社会家庭状况领域(SWB)、情感状况领域(EWB)、功能状况领域(FWB)评分及量表总分(TOTAL)均获得明显提升,差异有统计学意义(P<0.05)。结论 胫后动脉穿支皮瓣的穿支血管管径较粗,位置恒定,血供范围广,设计包容性强,修复部位及缺损程度多变,术后外观及功能恢复良好,患者生活质量得到明显提升。Objective To evaluate the clinical efficacy of posterior tibial artery perforator flap in the repair of postoperative defects in patients with lower extremity melanoma and cutaneous squamous cell carcinoma.Methods From June 2019 to June 2021,a total of 10 cases of lower extremity melanoma and 10 cases of lower extremity squamous cell carcinoma were selected as the research objects,and the posterior tibial artery perforator flap was used to repair the wound defect caused by extended resection.The area of lesions ranged from(2.0 cm×1.5 cm)to(9.0 cm×8.5 cm).The flap size ranged from(6.0 cm×5.0 cm)to(12.0 cm×9.0 cm).Postoperative adjuvant radiotherapy was performed for 5-8 weeks.The appearance and color of the flap,effect on motor function of lower limbs and prognosis of donor site were recorded in outpatient follow-up after operation.The quality of life of the patients with head and neck cancer was evaluated by FACT-HN.Results All the flaps of 20 patients in this study survived completely,and were followed up for 3-25 months in the outpatient clinic after operation.The flaps had good appearance,normal color,no ulcers,linear scar in the donor and recipient sites,and normal limb movement.Compared with pre-operation,the patients’scores in the fields of physiological status(PWB),social/family status(SWB),emotional status(EWB),functional status(FWB)and TOTAL score(TOTAL)were significantly improved,with statistical significance(P<0.05).Conclusion perforators of th e posterior tibial artery perforators flap vascular caliber coarser,location,constant,wide range of blood supply,strong design inclusive,repair parts and defect degree and changeful,appearance and function recovered well postoperativel y,patients’life quality significantly increased,repairing postoperative lower limb melanoma and squamous cell carcinoma of the skin defect in the ideal choice.

关 键 词：黑色素瘤 胫后动脉穿支皮瓣 组织缺损 修复 

分 类 号：R622.1[医药卫生—整形外科]