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股前外侧皮瓣在肿瘤外阴缺损修复中的应用。

Anterolateral thigh flap-based reconstruction for oncologic vulvar defects.

机构信息

Beijing, China From the Department of Plastic Surgery, Peking Union Medical College Hospital.

出版信息

Plast Reconstr Surg. 2011 May;127(5):1939-1945. doi: 10.1097/PRS.0b013e31820e9223.

Abstract

BACKGROUND

Vulvar defects after tumor extirpation always require immediate reconstruction. Transferring a skin flap from a distant region may be required for large defects. Although the anterolateral thigh flap has gained popularity in other types of oncoplastic surgery, it has rarely been reported for vulvar reconstruction. The aims of this retrospective study were to evaluate the outcome of anterolateral thigh flap-based vulvar reconstruction and to develop an operative strategy.

METHODS

Eleven patients with vulvar carcinoma underwent resection and immediate reconstruction with the anterolateral thigh flap between 2005 and 2009. Based on defect type and local soft-tissue quality, four types of anterolateral thigh flap-based reconstructions were performed: unilateral anterolateral thigh flap, ipsilateral anterolateral thigh flap combined with contralateral advancement flap or local flap, fenestrated anterolateral thigh flap, and split anterolateral thigh flap. Postoperative complications were recorded and clinical outcomes were evaluated.

RESULTS

Partial flap necrosis occurred in one patient with a fenestrated anterolateral thigh flap for bilateral reconstruction. One wound dehiscence occurred in the contralateral local flap. Two patients had prolonged serous drainage. Mean follow-up was 8 months. One patient developed stricture of the urethral meatus and another had regional metastasis.

CONCLUSION

With careful design, the anterolateral thigh flap may provide reliable and durable soft-tissue coverage for various vulvar defects with good outcomes and minimal donor-site morbidity.

摘要

背景

外阴肿瘤切除后常需要立即进行重建。对于较大的缺损,可能需要从远处转移皮瓣。尽管前外侧大腿皮瓣在其他类型的肿瘤整形手术中已得到广泛应用,但用于外阴重建的报道却很少。本回顾性研究旨在评估基于前外侧大腿皮瓣的外阴重建的结果,并制定手术策略。

方法

2005 年至 2009 年间,11 例外阴癌患者接受了前外侧大腿皮瓣切除和即刻重建。根据缺损类型和局部软组织质量,我们采用了 4 种基于前外侧大腿皮瓣的重建方法:单侧前外侧大腿皮瓣、同侧前外侧大腿皮瓣联合对侧推进皮瓣或局部皮瓣、开窗前外侧大腿皮瓣和分裂前外侧大腿皮瓣。记录术后并发症,并评估临床结果。

结果

1 例双侧重建采用开窗前外侧大腿皮瓣的患者发生部分皮瓣坏死。1 例对侧局部皮瓣发生伤口裂开。2 例患者出现浆液性引流时间延长。平均随访 8 个月。1 例患者出现尿道外口狭窄,另 1 例患者发生区域转移。

结论

精心设计的前外侧大腿皮瓣可为各种外阴缺损提供可靠和持久的软组织覆盖,具有良好的效果和最小的供区并发症。

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