皮肤恶性肿瘤手术治疗及美容修复临床探究.doc

皮肤恶性肿瘤手术治疗及美容修复临床探究[摘要]目的：探讨皮肤恶性肿瘤病灶彻底切除后美容修复的可行性。方法：按照无瘤技术完整切除肿瘤病灶，根据创面部位、大小、深度，遵照“宁近勿远，宁简勿繁”的原则，选择适宜的皮瓣、肌皮瓣或皮片修复创面；创面位于功能部位者采用分区植皮技术。术后根据肿瘤性质，选择放射治疗、化学治疗或免疫治疗等辅助治疗；伤口局部给予康复治疗。结果：基底细胞癌、鳞状细胞癌和恶性黑色素瘤仍是常见的皮肤恶性肿瘤，占本组198例患者的85.6%，共169例。实施皮片移植137例，其中全厚植皮62例，中厚植皮75例，111例实施分区植皮，皮片成活率均在95%以上；61例采用皮瓣或肌皮瓣修复创面，均100%成活；所有病例创面修复后外形均良好。160例患者得到6个月以上随访，15例死亡（6例死于其他疾病），16例发生局部复发或远处转移，其余患者术区外形良好，局部无复发。结论：按照无肿瘤技术彻底切除皮肤恶性肿瘤后，采用美学理论和整形美容技术修复创面可以达到美容修复的目的。 [关键词]恶性肿瘤；皮肤；手术治疗；美学；整形；美容技术；修复 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2011）06-0898-04 Clinical study on surgical treatment and cosmetic repair of skin m alignant tumor LIU Yi,ZHANG Chen,ZHANG Xu-sheng,ZHANG Xian-ying,LIU Ping,SONG Mei,XIAO Bin,JIANG Jiang (Center of Burns and Plastic Surgery of CPLA,Lanzhou General Hospital of Lanzhou Command, Lanzhou 730050,Gansu,China) Abstract:ObjectiveTo probe the feasibility of cosmetic repair after skin m alignant tumor being thoroughly excised.MethodsA focus was excised totally using no-tumor technique, then according to the site, area and depth of wound and the principle of “rather near than further, rather simple than complicated”, a flap or a musculocutaneous flap or skin graft was employed to repair the wound. If the wound located on function site, zonation grafting technique would be used. Radiotherapy, chemotherapy or immuno therapy was selected as an accessory treatment according to the property of tumor after operation. Local rehabilitation was carried out on wound.ResultsBasal cell caicinoma,squamous cell caicinoma and m alignant melanoma were still common m alignant tumor on skin, and they occupied 85.6% (169/198) in this group. Skin grafting was carried out in 137 cases, among them,full-thickness skin graft in 62 cases,split thickness skin graft in 75 cases, and zonation grafting technique was used in 111 cases.The survival rate of skin graft was over 95%. The skin flap or musculocutaneous flap were selected to repair wound in 61 cases, and all of them survived total