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目的总结纵形腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣移位修复外阴肿瘤根治术后缺损创面的方法及疗效。方法2007年8月-2009年8月,收治5例57～68岁女性外阴肿瘤患者。其中外阴鳞状细胞癌4例,外阴黑色素瘤1例。病程3～5年。患者均行外阴广泛局部扩大切除术加腹股沟及盆腔淋巴结清扫,肿瘤切除后创面缺损范围为12cm×7cm～15cm×6cm。采用大小为14cm×8cm～16cm×9cm的纵形DIEP皮瓣移位修复创面。供区直接缝合。结果术后1例皮瓣远端出现部分坏死,经换药后成活;其余4例均顺利成活。创面Ⅰ期愈合4例,Ⅱ期愈合1例。供区切口均Ⅰ期愈合。术后4例患者获随访,随访时间8个月～2年。1例因外阴鳞状细胞癌复发后不能耐受再次手术而死亡;1例外阴臃肿影响排尿,予皮瓣修整术后排尿恢复正常;余2例外阴无臃肿,皮瓣色泽与下腹壁皮肤相似,质地柔软,无尿道口狭窄。供区腹壁无并发症发生。结论纵形DIEP皮瓣移位是修复外阴肿瘤术后缺损创面的有效方法之一。
Objective To summarize the method and effect of deep inferior epigastric perforator (DIEP) flap transplantaion to repair the defect wound after radical operation of vulvar tumor. Methods From August 2007 to August 2009, 5 patients with vulvar tumors aged 57-68 years were admitted. Including vulvar squamous cell carcinoma in 4 cases, 1 case of vulvar melanoma. Duration of 3 to 5 years. All patients underwent extensive genital partial enlargement resection plus groin and pelvic lymph node dissection. The extent of wound defect after tumor resection ranged from 12cm × 7cm to 15cm × 6cm. Using the size of 14cm × 8cm ~ 16cm × 9cm vertical DIEP flap shift repair wound. The area for direct suture. Results One case had partial necrosis of the distal flap after operation and survived dressing change. The remaining four cases survived smoothly. Wound healing in 4 cases Ⅰ, Ⅱ in 1 case. District incision healed first. Four patients were followed up for 8 months to 2 years. One case died of recurrence of vulvar squamous cell carcinoma after recurrence; 1 case of vulva bloated affect urination, urination returned to normal after skin flap trimming operation; the other 2 cases of vulva were not bloated, the skin color of the flap was similar to that of the lower abdominal wall , Soft texture, no urethra stenosis. Abdominal wall for complications without complications. Conclusion Longitudinal DIEP flap displacement is one of the effective methods to repair the defect of vulva tumor after operation.