鼻部皮肤肿瘤切除后的创面修复

鼻部皮肤肿瘤切除后的创面修复

邢新　薛春雨　李军辉　张敬德　李蠡

【摘　要】 目的　介绍鼻部皮肤肿瘤切除后创面的即刻修复经验。　方法　1996年4月～2006年4月,在遵循鼻亚单位组成的美学原则基础上,根据创面大小、形状、部位及周围皮肤情况,选择相应局部皮瓣修复鼻部肿瘤切除后致鼻缺损428例。其中男273例,女155例;年龄12～78岁,中位年龄52岁。基底细胞癌146例,鳞状细胞癌83例,表皮囊肿54例,色素痣145例;恶性肿瘤临床分期0～ 期,病程1周～3个月。鼻尖51例,鼻翼102例,鼻背138例,鼻侧壁137例;其中跨鼻亚单位缺损83例。肿瘤切除后致鼻缺损016c m×016c m～310c m×410c m。皮瓣来源于额鼻皮瓣58例,双叶皮瓣67例,改良菱形皮瓣152例,鼻唇沟皮瓣118例,额正中皮瓣33例。供区创面直接拉拢缝合。　结果　患者创面 期愈合423例;3例皮瓣远端部分表皮坏死,经局部换药后创面愈合;2例患者切口轻度感染,经局部换药处理后创面 期愈合。供区均未形成继发性缺损,创面 期愈合。术后385例获随访1～60个月。鼻外形轮廓较好,修复组织色泽、质地与周围皮肤匹配良好,恶性肿瘤无复发。　结论　遵循鼻亚单位美学原则,应用局部皮瓣能修复鼻部肿瘤切除后中等以上创面,且色泽、质地、轮廓等均能达到较好匹配和协调,可获得满意功能和稳定的美学效果。

【关键词】 鼻皮肤肿瘤 继发创面 局部皮瓣 修复

中图分类号:R651　R628 文献标识码:A

RECONSTRUCTI ON OF NASAL D EFECT AFTER TU MOR EXC ISI ON X IN G X in,X U E Chuny u,L I J unhu i,et a l.

D ep a rt m en t of P lastic S u rg ery,Chang ha i H osp ita l,S econd M ilita ry M ed ica l U n iversity,S hang ha i,200433,P.R. Ch ina.E2m a il:x ing x in56@y ahoo.co

Corresp ond ing au thor:X IN G X in,E2m a il:x ing x in56@y ahoo.co

【Abstract】 Objective　To in troduce the experience and comp rehen si on to recon struct nasal defect after tumo r excisi on.M ethods　F rom A p ril1996to A p ril2006,based on the aesthetic subun it p rinci p le and acco rding to the size, shape,locati on of nasal defect and the conditi on s of su rrounding sk in,homo logou s local flap w as selected to cover the nasal defect in428cases w h ich nasal tumo rs w ere removed.Among428cases,there w ere273m en and155w om en, w ith a m edian age of52years(12278years);including146cases of basal cell carcinom a,83cases of squamou s cell carcinom a,54cases of ep iderm al cyst,and145cases of p igm en ted naevu s.T he clin ical stage of m alignan t tumo r w as 02 stage,the cou rse of disease w as1w eek to3mon th s.T he locati on s w ere nasal ti p in51cases,nasal ala in102 cases,do rsum of no se in138cases,and nasal side in137cases,acro ss2nasal subun its in83cases.T he area of the defect ranged betw een016c m×016c m and310c m×410c m.T he o rigin of flap s w as fron tonasal flap in58cases, b ilobed flap in67cases,refo rm ing rhom bo id flap in152cases,naso lab ial flap in118cses,fo rehead falp in33cases.T he secondary defect of dono r site w as directly su tu red.　Results　Among428cases,423cases acqu ired comp lete recovery; 3cases w h ich had ep iderm necro sis over the far end of the flap ach ieved healing by the first in ten ti on and2cases w h ich had suffered low2grade infecti on of incisi on ach ieved healing by the second in ten ti on after regi onal change dressings.T he nasal defect w as successfu lly repaired in all patien ts,and the all flap s su rvived.A to tal of385patien ts w ere availab le fo r fo llow2up of1to60mon th s,no tumo r recu rrence occu rred,and the repaired tissue w ere good m atch w ith su rrounding tissue,good nasal con tou r w as ob tained,the co s m etic resu lts w ere satisfacto ry.Conclusion　Based on the nasal aesthetic subun it p rinci p le,the local flap can recon struct the nasal above m edial defect,and a good co lo r,con tou r and tex tu re m atch w ith the su rrounding sk in can be ob tained,the co s m etic resu lts are satisfacto ry.

【Key words】　N asal cu taneou s tumo r Secondary defect L ocal flap R epair

鼻部皮肤松动性较小,尤其是鼻尖、鼻翼部位。鼻部皮肤软组织肿瘤切除后,创面往往不能直接缝合封闭,常需采用皮片移植等方法覆盖创面。而鼻位于面部

作者单位:第二军医大学附属长海医院整形外科(上海,200433)

通讯作者:邢新,教授,博士导师,研究方向:自体组织移植,E2m ail: xingxin56@ 正中,在面部形态和美学上有重要地位,鼻部缺损创面的修复效果直接影响面部形态结构和美学效果。为使修复鼻部创面的组织在色泽、质地及结构特征等方面与创面周围皮肤能匹配、协调,术后获得较好的功能和美学效果,1996年4月～2006年4月,我们在遵循鼻亚单位组成的美学原则基础上,根据鼻部皮肤软组织肿瘤切除后创面的部位、大小、深度及供区组织可利用情