Liang W Q, Shi F, Zhang J, Zhang J Q, Xiao X L, Zhang J M
Department of Plastic Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, China.
Zhonghua Shao Shang Za Zhi. 2021 Apr 20;37(4):363-368. doi: 10.3760/cma.j.cn501120-20200227-00099.
To explore the indications, selection, and effect of flap application in repairing scar carcinoma in the lower leg and ankle. A retrospective cohort study was conducted. From June 2008 to December 2018, six male patients with scar carcinoma in the lower leg and ankle were treated in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, aged 48-64 years, with the area of lesion ranging from 3 cm×2 cm to 15 cm×6 cm. After extended resection, the defect area ranged from 8 cm×5 cm to 22 cm×9 cm, with tissue of tendon or bone exposed. Free anterolateral thigh perforator flap, latissimus dorsi myocutaneous flap, or pedicled sural neurovascular flap was selected to repair the wound according to the location of wound in the lower extremity, selection of operation position, the location of the anastomotic vessels in the recipient area, and whether there was good skin and soft tissue available in the lower leg. The size of flap was 11 cm×8 cm-26 cm×10 cm. The donor site of free flap or myocutaneous flap was closed directly by suturing in 5 cases, and the donor site of pedicled flap was repaired with full-thickness skin graft in 1 case. The blood supply and survival of flap, quality of skin graft survival, and complication were observed postoperatively. During the follow-up period, the recurrence and metastasis of scar carcinoma, and the appearance and function of donor and recipient sites were observed. All the patients completed the operation successfully, all the transplanted flaps survived with good blood supply, and the skin graft in one donor site survived well. The wounds in the donor and recipient sites of all the patients healed well without infection, effusion, or dehiscence, etc. All the patients were followed up for 1-5 years. No local recurrence or distant metastasis of scar carcinoma was found. The quality of the transplanted flaps was good. The shape of the recipient area was quite good, and the function of the affected limb was fine. The appearance of the donor area was good without dysfunction. Flap transplantation is suitable for the patients with tendon and bone exposure after the excision of scar carcinoma in the lower leg and ankle. The flap can be selected according to the location of scar carcinoma, operation position, the location of anastomotic vessels in the recipient area, and whether there is good skin and soft tissue available in the lower leg. The free anterolateral thigh perforator flap or latissimus dorsi myocutaneous flap is an ideal choice for repair, which can be obtained in a large area, and the donor site can be directly sutured without affecting the function.
探讨皮瓣修复小腿及踝关节瘢痕癌的适应证、选择及效果。进行一项回顾性队列研究。2008年6月至2018年12月，中山大学孙逸仙纪念医院收治6例小腿及踝关节瘢痕癌男性患者，年龄48 - 64岁，病变面积3 cm×2 cm至15 cm×6 cm。扩大切除后，缺损面积8 cm×5 cm至22 cm×9 cm，伴有肌腱或骨质外露。根据下肢创面位置、手术体位选择、受区吻合血管位置以及小腿是否有良好的皮肤软组织，选择游离股前外侧穿支皮瓣、背阔肌肌皮瓣或带蒂腓肠神经营养血管皮瓣修复创面。皮瓣大小为11 cm×8 cm - 26 cm×10 cm。5例游离皮瓣或肌皮瓣供区直接缝合关闭，1例带蒂皮瓣供区采用全厚皮片修复。术后观察皮瓣血运及存活情况、皮片存活质量及并发症。随访期间，观察瘢痕癌的复发转移情况及供受区外观和功能。所有患者手术均成功完成，所有移植皮瓣血运良好存活，1个供区皮片存活良好。所有患者供受区创面愈合良好，无感染、积液、裂开等情况。所有患者随访1 - 5年，未发现瘢痕癌局部复发或远处转移。移植皮瓣质量良好。受区外形良好，患肢功能正常。供区外观良好，无功能障碍。皮瓣移植适用于小腿及踝关节瘢痕癌切除后伴有肌腱和骨质外露的患者。可根据瘢痕癌位置、手术体位、受区吻合血管位置以及小腿是否有良好的皮肤软组织选择皮瓣。游离股前外侧穿支皮瓣或背阔肌肌皮瓣是修复的理想选择，可切取面积大，供区可直接缝合不影响功能。
