带蒂皮瓣修复鼻部基底细胞癌术后缺损.docVIP

带蒂皮瓣修复鼻部基底细胞癌术后缺损(上海市第一人民医院整形外科　上海200080) 黄燮青　男，1952年生，1978年上海第一医学院医疗系毕业，现任上海市第一人民医院整形外科副主任医师，发表学术论文多篇。［摘　要］　目的：介绍带蒂皮瓣在修复鼻部基底细胞癌术后缺损的临床经验。　方法：位于鼻尖或鼻根部术后缺损用前额皮瓣修复7例，鼻翼部缺损用鼻唇沟皮瓣修复11例。　结果：皮瓣转移后出现静脉回流不畅现象，将皮瓣远端修薄后作打包缝合2例，术后皮瓣边缘有部分坏死1例，其余皮瓣均存活。术后外形满意、肿瘤无复发。　结论：带蒂皮瓣具有血供可靠，操作简便，供区隐蔽，特别适用于一期修复鼻部基底细胞癌术后的缺损畸形。 ［关键词］　皮瓣　修复　鼻缺损　基底细胞癌 ［中图分类号］R762　［文献标识码］A　［文章编号］1008-6455(2000)06-0446-02 REPAIR THE DEFECT AFTER THE OPERATION OF NASAL BASAL CELL CARCINOMA WITH PEDICLE SKIN FLAP HUANG Xie-qing　SHEN Hua Department of Plastic Surgery,Shanghai First Peoples Hospital(Shanghai 200080) [Abstract] Objective:To introduce the clinical results by using the pedicle skin flap to repair the defect of nasal basal cell carcinoma after the operation. Methods:7 cases of the defects on nose-tip or nasion after the operations were repaired with forehead skin flap,11 cases of the defects on nasal alae with naso-labial skin flap. Results:The flaps appeared to be venous return dysfunctual and were sutured with package under pressure after thinning the distant parts on 2 cases.Necrosis of the edge of the flap was happened on 1 case.Others were survived. The shapes of the flap were satisfactory.No tumor recurred. Conclusion:The pedicle skin flaps blood supply is reliable,method is simple and the donor site is concealed.The flap is especially suitable for one stage to repair the postoperative defect of nasal basal cell carcinoma. [key words]　Flap　Repairation　Nasal defect　Basal cell carcinoma 鼻部基底细胞癌是颜面部常见的低度恶性肿瘤，但切除后造成缺损畸形影响面部美观，甚至可造成患者心理上的创伤。选用邻近带蒂皮瓣修复鼻部缺损区能恢复鼻部正常外形。该手术具有方法简便、疗效可靠、供区隐蔽等优点，病人容易接受。我科从1980年～1999年采用带蒂皮瓣修复鼻部基底细胞癌切除后缺损18例，均取得了良好的临床效果。本文就手术方法、术式选择及术中注意事项作以讨论。 1　临床资料 1.1　一般情况　本组18例中，男性11例，女性7例。年龄48岁～73岁。肿瘤性质均被病理证实。 1.2　肿瘤部位及大小　生长在鼻翼的11例，鼻背根部4例，鼻尖3例。肿瘤直径小于1cm的2例，肿瘤直径在1cm～1.5cm的4例，肿瘤直径在1.6cm～2cm的6例，肿瘤直径在2.1cm～2.5cm的4例，肿瘤直径大于2.5cm的2例。其中2例已在门诊作肿块切除术，切口直接缝合，术后病理诊断为基底细胞癌，因切缘有肿瘤组织残迹，再次手术。术后病人随访6年～8年无复发。 1.3　移植皮瓣情况　选用带皮下蒂鼻唇沟皮瓣11例，前额皮瓣7例。皮瓣切取最大面积2.5cm×3cm，最小面积1.5c