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目的探讨改良双叶瓣修复颧面部皮肤癌切除术后缺损的疗效。方法 2009年8月-2011年10月,收治颧面部皮肤癌患者15例。男12例,女3例;年龄52～78岁,平均64.1岁。病程1～14个月,平均4.6个月。基底细胞癌11例,鳞状细胞癌4例。术前1例肿瘤病灶合并感染,余患者皮肤均无破溃;肿瘤均累及皮肤层。TNM分期:T2N0M213例,T3N0M3患者2例。肿瘤病灶切除后遗留缺损范围为4.0 cm×2.5 cm～6.5 cm×4.0 cm。采用改良的耳前、耳后双叶瓣修复缺损,切取范围第1叶皮瓣4.0 cm×2.5 cm～6.5 cm×4.0 cm,第2叶皮瓣3.0 cm×2.0 cm～5.0 cm×3.0 cm。结果术后1例切口部分裂开,经换药后痊愈;余患者皮瓣均顺利成活,切口均Ⅰ期愈合。14例获随访,随访时间12～24个月,平均18.7个月。患者面部无明显不对称,眼睑闭合无影响,无面神经损伤表现。随访期间均无肿瘤复发。末次随访时患者满意度评分:不满意1例,可以接受1例,比较满意7例,非常满意5例。结论使用改良耳前、耳后双叶瓣修复颧面部皮肤癌术后缺损可获得较好效果,且并发症少。
Objective To investigate the curative effect of modified bilobal flap for the repair of zygomatic facial skin cancer after resection. Methods From August 2009 to October 2011, 15 patients with zygomatic facial skin cancer were treated. There were 12 males and 3 females, ranging in age from 52 to 78 years with an average of 64.1 years. Duration of 1 to 14 months, an average of 4.6 months. Basal cell carcinoma in 11 cases, squamous cell carcinoma in 4 cases. Preoperative tumor lesions in 1 case with infection, the patient’s skin were not ulcerated; tumors are involved in the skin layer. TNM staging: T2N0M213 cases, T3N0M3 patients in 2 cases. The number of residual lesions after tumor resection was 4.0 cm × 2.5 cm to 6.5 cm × 4.0 cm. The defect of first leaf flap was cut from 4.0 cm × 2.5 cm to 6.5 cm × 4.0 cm and the second flap was 3.0 cm × 2.0 cm to 5.0 cm × 3.0 cm. Results One case of incision was split after operation, and recovered after dressing change. The flaps of the remaining patients survived smoothly and the incisions healed in the first stage. Fourteen patients were followed up for 12-24 months with an average of 18.7 months. No obvious facial asymmetry in patients with closed eyelid no facial nerve damage performance. No tumor recurrence during follow-up. Satisfaction score at the last follow-up: unsatisfactory in 1 case, acceptable in 1 case, more satisfied in 7 cases, very satisfied with 5 cases. Conclusion The modified anterior ear and ear bilobal flap repair of zygomatic facial skin cancer postoperative defect can be obtained with good results, and fewer complications.