应用瓦合式游离背阔肌肌皮瓣修复面中部肿瘤切除术后洞穿性缺损.docVIP

应用瓦合式游离背阔肌肌皮瓣修复面中部肿瘤切除术后洞穿性缺损[摘要]目的:探讨应用瓦合式游离背阔肌肌皮瓣修复面中部皮肤恶性肿瘤切除术后洞穿性缺损的方法。方法:对下睑、内眦等面中部复发肿瘤进行扩大根治切除。对于切除肿瘤后形成的洞穿性缺损,应用瓦合式游离背阔肌肌皮瓣进行修复。结果:应用瓦合式游离背阔肌肌皮瓣修复面中部皮肤恶性肿瘤切除术后洞穿性缺损9例,肌皮瓣全部成活,外形良好。术后半年复查未见局部复发。3例患者于术后半年接受皮瓣去脂术。结论:应用瓦合式游离背阔肌肌皮瓣修复面中部皮肤恶性肿瘤切除术后洞穿性缺损成功率高,可达到功能和外形同时修复的效果。 [关键词]洞穿性缺损;肿瘤;修复;游离背阔肌肌皮瓣 [中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)05-0643-03 To reconstruct the midface cavity defect after tumorrectomy by free two-double latissimus myocutaneous flap YANG Li,PAN Yong,XIA Wen-sen,GUO Shu-zhong,HAN Yan (Institute of Plastic Surgery,Xijing Hospital,the Fourth Military Military Mediacal University, Xi’an 710032,Shaanxi,China) Abstract:ObjectiveTo investigate the correction of the midface cavity defect after tumorectomy by free two-double latissimus dorsimyocutaneous flap.MethodsTo extended excise the midface ecrudescent tumor in the lower eyelid or endocanthion. Then the cavity defect after tumor rectomy was reconstructed by free two-double latissimusdorsi myocutaneous flap.Results9 cases with severe cavity defects were treated by free two-double latissimus dorsi myocutaneous flap.All free flaps were survived. No tumors recur happened after 6 months. 3 flaps were defatted after 6 months.ConclusionIt is helpful to get better improvement in the function and reshaping effect we treat the midface cavity defect after tumorectomy by free two-double latissimus dorsi myocutaneous flap, which have a higher achievement ratio to reduce the tumor recur. Key words: cavity defect; tumor; reconstruction; free two-double latissimus dorsi myocutaneous flap 颌面部恶性肿瘤根治切除术后所致的洞穿性缺损,严重影响患者的容貌及呼吸、咀嚼等功能。没有修复技术的保证,则可能限制对颌面部恶性肿瘤的根治性切除,从而影响生存率及生存质量。笔者于2005年1月～2008年12月采用瓦合式游离背阔肌肌皮瓣修复颌面部洞穿性缺损9例,功能及外形均取得满意的效果。 1临床资料 本组9例患者,其中男性6例,女性3例,年龄34～69岁,下睑基底细胞癌6例,内眦部鳞状细胞癌3例,均为手术后复发患者。来我科就诊前均已在外院接受手术1～3次。术前常规CT或MRI检查显示:9例患者复发肿瘤都侵犯下睑和面部皮肤,均不同程度侵及眼眶、眶内容物、鼻腔、上颌窦、筛窦鼻骨等邻近组织。肿瘤根治手术所致面部洞穿性缺损并眶内容物缺损畸形均采用瓦合式游离背阔肌肌皮瓣I期修复,9例全部成活(100%)。背阔肌肌皮瓣供区直接拉拢缝合。肌皮瓣受区常规放置负压引流,于术后24～48h拔除。9例患者伤口均I期愈合