各种皮瓣在足底负重区恶性黑色素瘤术后缺损修复中的应用

发布时间：2018-04-01 22:38

本文选题：黑色素瘤　切入点：足　出处：《中华肿瘤防治杂志》2014年11期

【摘要】：目的:探讨足底内侧皮瓣、局部逆行岛状皮瓣、外踝上穿支皮瓣、内踝上穿支皮瓣和游离股前外侧皮瓣修复足底负重区恶性黑色素瘤广泛切除术后缺损的优缺点。方法:浙江省肿瘤医院骨和软组织肿瘤外科2010-01-13-2013-12-25收治的23例足底负重区皮肤恶性黑色素瘤患者,进行原发灶广泛切除后分别采用足底内侧皮瓣、局部逆行岛状皮瓣、外踝上穿支皮瓣、内踝上穿支皮瓣及游离股前外侧皮瓣进行修复,对其临床资料和随访结果进行分析。结果:术后缺损面积为4cm×4cm~11cm×9cm,切取皮瓣面积5cm×5cm~12cm×10cm。14例足底内侧皮瓣全部成活,其中皮瓣最大切取面积为7cm×7cm。1例局部逆行岛状皮瓣出现小部分坏死,二期愈合,4例外踝上及内踝上穿支皮瓣全部成活,其中皮瓣最大切取面积为12cm×10cm。4例游离股前外侧皮瓣中,3例成活,1例皮瓣出现远端部分浅表性坏死,经换药后愈合。所有患者无继发性溃疡出现,患足均可无痛行走。2例行足底内侧皮瓣修复术后出现局部复发。结论:各种皮瓣修复足底黑色素瘤术后缺损均可获得较好疗效,对较小足根部的缺损(直径8cm)首选足底内侧皮瓣,较大的缺损可采用内外踝上穿支皮瓣,有显微外科条件的可考虑游离股前外侧皮瓣修复局部皮瓣不能覆盖的缺损。
[Abstract]:Objective: to investigate the advantages and disadvantages of medial plantar flap, local retrograde island flap, lateral supramalleolar perforator flap, medial superior malleolus perforator flap and free anterolateral femoral flap in repairing the defects of malignant melanoma in plantar bearing area after extensive excision.Methods: Twenty-three patients with malignant melanoma in plantar bearing area were treated by bone and soft tissue tumor surgery in Zhejiang Provincial Oncology Hospital from 2010-01-13-2013-12-25. The patients were treated with medial plantar flap and local retrograde island flap after extensive excision of primary lesions.The supramalleolar perforator flap, medial supramalleolar perforator flap and free anterolateral femoral flap were repaired. The clinical data and follow-up results were analyzed.Results: the defect area was 4cm 脳 4cm~11cm 脳 9 cm. The flap area of 5cm 脳 5cm~12cm 脳 10cm.14 survived. The maximum area of the flap was 7cm 脳 7cm.1.Four cases of lateral and medial supramalleolar perforator flaps survived in the second stage of healing. The maximum area of the flap was 12cm 脳 10cm.4. Of the 4 cases of free anterolateral femoral flap, 3 cases survived and 1 case had superficial necrosis of distal part, which healed after dressing change.There were no secondary ulcers in all patients, and local recurrence was found in 2 cases of painless walking with medial plantar flap repair.Conclusion: all kinds of flaps can be used to repair the defects of melanoma plantar. The medial plantar flap is the first choice for the defect of the root of the foot (diameter 8 cm), and the larger flap can be used as the perforating branch flap of the medial and lateral malleolus.Free anterolateral thigh flap can be considered to repair the defect which can not be covered by local flap under microsurgical conditions.
【作者单位】：浙江省肿瘤医院骨和软组织肿瘤外科;杭州市整形医院手外科;
【分类号】：R739.5

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