Xiao Haitao, Wang Huaisheng, Liu Xiaoxue, Liu Yong, Cen Ying
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Jan;30(1):87-90.
To investigate the effectiveness of different free flaps in the repair of large defects after resection of scalp malignant tumors.
Between March 2012 and January 2015, 18 patients with large defect after resection of scalp malignant tumors were treated with different free flaps. There were 13 males and 5 females with an average age of 49 years (range, 18-72 years). There were 17 cases of squamous carcinoma and 1 case of dermatofibril sarcoma protuberans. The defect size ranged from 15 cm x 12 cm to 22 cm x 17 cm after resection of tumors. Defects were repaired with anterolateral thigh flap in 5 cases, latissimus dorsi myocutaneous flap in 6 cases, thoracodorsal artery perforator flap in 3 cases, and latissimus dorsi muscle flap plus intermediate split thickness skin graft in 4 cases. The flap size was 17 cm x 14 cm to 24 cm x 19 cm. The donor sites of the skin flap were covered with skin graft, while the donor sites of the muscle flap were directly sutured.
Of 14 skin flaps, the other 13 flaps survived except 1 flap necrosis; all muscle flaps survived. The patients were followed up 5-33 months (mean, 20 months). Three patients died because of intracranial metastasis at 5, 7, and 13 months after operation, respectively. Two patients had local recurrence and underwent secondary operation. The results of both appearance and function were satisfactory; secondary operation of thinning the flaps was performed in 4 cases of bulky flaps. The flaps had good wear resistance, without ulceration during follow-up. No obvious impairment was observed after harvesting latissimus dorsi myocutaneous flap.
Large scalp defects after malignant tumor resection can be effectively repaired by proper application of different free flaps.
探讨不同游离皮瓣修复头皮恶性肿瘤切除术后大面积缺损的有效性。
2012年3月至2015年1月，对18例头皮恶性肿瘤切除术后出现大面积缺损的患者采用不同游离皮瓣进行治疗。其中男性13例，女性5例，平均年龄49岁（范围18 - 72岁）。鳞状细胞癌17例，隆突性皮肤纤维肉瘤1例。肿瘤切除后缺损大小为15 cm×12 cm至22 cm×17 cm。5例采用股前外侧皮瓣修复，6例采用背阔肌肌皮瓣修复，3例采用胸背动脉穿支皮瓣修复，4例采用背阔肌肌瓣加中厚断层皮片移植修复。皮瓣大小为17 cm×14 cm至24 cm×19 cm。皮瓣供区采用植皮覆盖，肌瓣供区直接缝合。
14例皮瓣中，除1例皮瓣坏死外，其余13例皮瓣存活；所有肌瓣均存活。患者随访5 - 33个月（平均20个月）。3例患者分别于术后5、7和13个月因颅内转移死亡。2例患者局部复发并接受二次手术。外观和功能结果均满意；4例皮瓣臃肿患者进行了皮瓣变薄二次手术。皮瓣耐磨性好，随访期间无溃疡形成。切取背阔肌肌皮瓣后未观察到明显功能障碍。
合理应用不同游离皮瓣可有效修复头皮恶性肿瘤切除术后的大面积缺损。
