Anthony J P, Mathes S J, Hoffman W Y
Division of Plastic and Reconstructive Surgery, University of California, San Francisco.
Surg Gynecol Obstet. 1993 Apr;176(4):355-9.
Fifty-one patients with large surgical defects after tumor resection (range of 100 to 1,050 centimeters squared, mean of 259 centimeters squared) were treated with immediate flap coverage. Indications for flaps were exposed vital structures, a wound bed unsuitable for skin grafting or planned postoperative radiation. Patients were divided into three groups based on tumor location--head and neck, trunk and perineum and groin and extremity. Sixty-eight flaps (11 free and 57 pedicled) were used and all wounds ultimately healed. Overall, extensive complications occurred in eight patients, lesser complications in 11 patients and initial flap loss in three patients. While complications delayed healing, all defects were ultimately successfully covered using flaps. Preferred flap choices for each anatomic area are presented. By providing immediate coverage of these massive defects, flaps allow wide tumor resection that improves palliation and chance for cure. Flaps tolerate postoperative radiation well and do not obscure recurrence if careful follow-up examination is given.
51例肿瘤切除术后存在大面积手术缺损的患者（缺损面积范围为100至1050平方厘米，平均为259平方厘米）接受了即刻皮瓣覆盖治疗。皮瓣覆盖的指征包括重要结构外露、不适宜植皮的创面床或计划进行术后放疗。根据肿瘤位置，患者被分为三组——头颈部、躯干与会阴以及腹股沟与四肢。共使用了68块皮瓣（11块游离皮瓣和57块带蒂皮瓣），所有创面最终均愈合。总体而言，8例患者出现严重并发症，11例患者出现较轻并发症，3例患者出现皮瓣早期坏死。虽然并发症延迟了愈合，但所有缺损最终均成功通过皮瓣覆盖。文中介绍了每个解剖区域的首选皮瓣选择。通过即刻覆盖这些大面积缺损，皮瓣使得广泛的肿瘤切除成为可能，从而改善了姑息治疗效果和治愈机会。皮瓣对术后放疗耐受性良好，并且如果进行仔细的随访检查，不会掩盖复发情况。
