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目的探讨穿支螺旋桨皮瓣修复四肢软组织恶性肿瘤切除后创面的可行性和技术要点。方法2008年7月-2015年7月,应用穿支螺旋桨皮瓣修复四肢软组织恶性肿瘤切除后创面19例。其中男13例,女6例;年龄20~82岁,平均53.4岁。病程1~420个月,平均82个月。肿瘤位置:大腿10例,膝关节附近2例,小腿2例,上臂1例,肘关节附近3例,前臂1例。肿瘤切除后皮肤软组织缺损范围4 cm×4 cm~24 cm×16 cm,共应用23个穿支螺旋桨皮瓣(8 cm×3 cm~30 cm×13 cm)修复肿瘤切除后创面,穿支血管源动脉包括股动脉2例、股深动脉3例、旋髂浅动脉1例、旋股外侧动脉6例、膝上外动脉2例、腓动脉2例、胫前动脉1例、肱动脉4例、桡动脉1例及自由设计的穿支皮瓣1例。结果术后20个皮瓣全部成活;3个皮瓣(旋转角度分别为180、150、100°)出现皮瓣远端部分坏死,其中2个清创后植皮修复,1个清创后用自由设计的小腿穿支皮瓣修复;供、受区切口均Ⅰ期愈合。患者均获随访,随访时间3个月~5年,平均19个月。无感染、血肿、皮瓣全部坏死等严重并发症发生。随访期间1例肘部皮肤恶性黑色素瘤患者术后1年半肿瘤复发,再次行手术切除;其余患者未见肿瘤复发。皮瓣色泽、质地及弹性佳,无挛缩,供区外观良好。结论应用穿支螺旋桨皮瓣修复四肢软组织恶性肿瘤切除后创面,手术操作简便,无需牺牲主干血管,是一种可靠的修复方法。
Objective To investigate the feasibility and technical points of repairing wounds after removal of soft tissue malignant tumor of extremities with a perforated propeller flap. Methods From July 2008 to July 2015, 19 cases of excision of soft tissue malignant tumor of the extremities were repaired with perforated propeller flaps. Including 13 males and 6 females; aged 20 to 82 years, mean 53.4 years old. Duration of 1 ~ 420 months, an average of 82 months. Tumor Location: Thigh in 10 cases, 2 cases near the knee, 2 cases of lower leg, 1 case of upper arm, 3 cases near the elbow and 1 case of forearm. Tumor resection after skin soft tissue defect range 4cm × 4cm ~ 24cm × 16cm, a total of 23 perforating screwdriver flaps (8cm × 3cm ~ 30cm × 13cm) repair of tumor resection after the wound, perforating blood vessels The source arteries included 2 femoral arteries, 3 deep femoral arteries, 1 inferior iliac artery, 6 circumflex femoral arteries, 2 external arteries, 2 peroneal arteries, 1 anterior tibial artery, 4 brachial arteries 1 case of radial artery and 1 case of freely designed perforator flap. Results All flaps survived after operation. Three flaps (rotation angles of 180, 150 and 100 °, respectively) showed partial necrosis of the distal part of the skin flap. Two of them were repaired by debridement and one was debridement after debridement The design of the calf perforating skin flap repair; for the incision by the district were healed. All patients were followed up for 3 months to 5 years with an average of 19 months. No infection, hematoma, flap necrosis and other serious complications. One case of malignant melanoma with elbow skin recurrence in 1 year and a half after operation was followed up for surgical resection. No recurrence was found in the rest of the patients. Flap color, texture and flexibility, no contracture, for the appearance of a good area. Conclusion It is a reliable method to repair wounds after removal of malignant tumors of extremities by using perforated propeller flaps. The operation is simple and convenient without sacrificing the main blood vessels.