Bare R L, Assimos D G, McCullough D L, Smith D P, DeFranzo A J, Marks M W
Department of Urology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.
Urology. 1994 Oct;44(4):557-61. doi: 10.1016/s0090-4295(94)80059-6.
The use of deep inferior epigastric artery (DIEA) rectus abdominis muscle flaps in conjunction with inguinal lymphadenectomy to treat patients with squamous cell carcinoma (SCC) of the penis having high-volume inguinal lymph node metastases causing skin breakdown and secondary infection is described.
Three patients with invasive SCC of the penis who had extensive unilateral inguinal nodal metastases with skin breakdown and secondary infection underwent pelvic lymphadenectomy and attempted wide resection of the superficial and deep inguinal lymph nodes. One patient had unresectable deep inguinal metastases and received postoperative radiation therapy. A DIEA rectus abdominis muscle flap was utilized to close the resulting groin defect.
Pathologic analysis demonstrated no pelvic lymph node metastases in any of the patients, superficial inguinal lymph node metastases in 1, and superficial and deep inguinal lymph node involvement in 2. All wounds healed well. The 2 patients with deep inguinal metastases experienced local disease progression. One patient died 7 months postoperatively of complications from chronic renal failure but had no evidence of tumor recurrence or wound problems. Another patient died of recurrent disease.
A rectus abdominis muscle flap may be a useful adjunct for managing certain patients with penile cancer and extensive suppurative inguinal lymph node metastases.
描述使用腹壁下深动脉（DIEA）腹直肌皮瓣联合腹股沟淋巴结清扫术治疗阴茎鳞状细胞癌（SCC）且腹股沟淋巴结转移量大导致皮肤破溃和继发感染的患者。
3例阴茎浸润性SCC患者，有广泛的单侧腹股沟淋巴结转移伴皮肤破溃和继发感染，接受了盆腔淋巴结清扫术，并尝试广泛切除浅表和深部腹股沟淋巴结。1例患者有无法切除的深部腹股沟转移灶，术后接受了放射治疗。使用腹壁下深动脉腹直肌皮瓣来闭合由此产生的腹股沟缺损。
病理分析显示，所有患者均无盆腔淋巴结转移，1例有浅表腹股沟淋巴结转移，2例有浅表和深部腹股沟淋巴结受累。所有伤口愈合良好。2例有深部腹股沟转移的患者出现局部疾病进展。1例患者术后7个月死于慢性肾衰竭并发症，但无肿瘤复发或伤口问题的证据。另1例患者死于复发性疾病。
腹直肌皮瓣可能是治疗某些阴茎癌伴广泛化脓性腹股沟淋巴结转移患者的有用辅助手段。
