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目的探讨足跟恶性黑色素瘤的切除范围及修复方法。方法 2007年7月-2009年6月,收治足跟恶性黑色素瘤15例。男9例,女6例;年龄32～71岁,平均47.2岁。其中原发初治13例,外院局部切除术后2例。病灶范围1.3cm×0.5cm～5.0cm×3.5cm,病灶厚度0.6～7.2mm。根据美国癌症联合会(AJCC)分期:ⅠA期1例,ⅠB期2例,ⅡA期3例,ⅡB期5例,ⅡC期1例,Ⅲ期3例。局部广泛切除后分别采用大小为7cm×5cm～12cm×8cm的足内侧皮瓣(5例)、足外侧皮瓣(2例)及腓肠神经营养血管逆行皮瓣(8例)进行修复;3例行淋巴结清扫术。供区植皮修复。结果术后1例足外侧皮瓣局部皮缘坏死,2例足内侧皮瓣供区出现部分植皮坏死,均经换药后愈合;其余皮瓣及植皮均成活,切口Ⅰ期愈合。术后15例均获随访,随访时间12～36个月,平均21个月。足外侧皮瓣感觉及功能恢复佳,足内侧皮瓣次之,腓肠神经营养血管逆行皮瓣较差。随访期间无局部复发;5例出现腹股沟淋巴结转移,其中1例死于肺转移。结论足跟恶性黑色素瘤行广泛切除后可获得较好局部控制率;应用局部皮瓣可修复创面,但腓肠神经营养血管逆行皮瓣的感觉恢复较差。
Objective To investigate the excision range and repair method of heel malignant melanoma. Methods From July 2007 to June 2009, 15 cases of heel malignant melanoma were treated. 9 males and 6 females; aged 32 to 71 years, an average of 47.2 years old. Among them, 13 cases had primary initial treatment and 2 cases after partial resection. Lesions range 1.3cm × 0.5cm ~ 5.0cm × 3.5cm, focal thickness 0.6 ~ 7.2mm. According to the American Cancer Society (AJCC) stage: 1 case of stage IA, 2 cases of stage IB, 3 cases of stage IIA, 5 cases of stage IIB, 1 case of stage IIC and 3 cases of stage III. After partial excision, the medial pedicel flap (5 cases), the lateral pedicel flap (2 cases) and the sural neurovascular retrograde flap (8 cases) were repaired with 3cm × 5cm ~ 12cm × 8cm, respectively. Routine lymph node dissection. For the skin graft repair. Results One case had partial necrosis of the skin flap on the lateral side of the foot and two cases of skin flap necrosis on the donor side of the medial flap. All the skin flap healed after dressing change. The remaining flaps and skin grafts survived and the incision healed in the first stage. All patients were followed up for 12 to 36 months (average 21 months). Foot lateral flap sensory and functional recovery is good, followed by the medial flap, sural neurovascular retrograde flap is poor. No local recurrence during follow-up; 5 cases of inguinal lymph node metastasis, of which 1 died of lung metastases. Conclusions The hemi - hemangioma of the heel with extensive excision results in a better local control rate. Local flap can repair the wound, but the retrograde flap with sural neurocutaneous vascular prosthesis has a poor sensory recovery.