皮肤扩张术治疗颜面部大面积黑色素痣.docxVIP

皮肤扩张术治疗颜面部大面积黑色素痣 The treatment of giant facial melanocytic nevi with skin expansion YAN Yu-hua，ZHU Li-kun ，WANG Ji-hua， ZHANG Jing-bo， GUO Qu，n HE Yong-jing ，TANG Ting，ZHANG Ying-jia (Department of Plastic Surgery ，The Second Affiliated Hospital of Kunming Medical University ， Kunming 650101 ， Yunnan， China ) ： Objective To discuss the method and effect of treating giant facial melanocytic nevi with skin expansion. Methods From May 2007 to May 2014 ， we treated all hospitalized patients who were with giant facial melanocytic nevi with soft tissue expansion.The expanders were implanted into around lesion or into distal aera of lesion ( forehead ，the upper arm ，deltopectoral aera )and been expanding for 2-3 months ， and expanded flaps were transferred to repair the detect. Results 24 cases were treated with this method , 2cmx 2cm necrosis of the distal end of flap accured in 1 case， which were healed with scar after dressing ， 2 cases were treated combine with skin graft ， 21cases recomed will in which the color ， texture ， thickness of repaired area were in accordance with around skin. Conclusion Skin expansion treatment is a safe and effective method of treating giant facial melanocytic nevi. 色素痣( melanotic nevus )，是由含有色素的痣细胞所构 成的最常见的皮肤良性色素斑块。病理上分为皮内痣、混合痣、 交界痣。 色素痣分布在全身各处， 需进行整形美容外科手术的多 集中在面部，色素痣70%- 90%子发于面部，面部色素痣伤害患 者的容貌及心理，影响患者的工作、学习和生活 [1] 。在任何区 域中的黑色素痣面积在144cm2以上，或直径超过20cm,或躯干 及四肢上面积超过900cm2就称为巨型先天性黑色素细胞痣 [2-3] ，当黑痣色素加深、增大，或有瘙痒、疼痛、破溃及出血 时，可能为恶性变 [4] 。而大面积黑色素痣恶变可能更高，故应 尽早做手术切除。 为了提供与面部组织结构及色泽相近的皮肤组 织，有效减少瘢痕产生及降低继发畸形的出现， 我科应用扩张器 对黑色素痣周围不同部位进行皮肤扩张修复颜面部黑毛痣手术 后组织缺损取得了良子的效果，现报道如下。 1 资料和方法 1.1 一般资料 本组共 24例，其中男 13例，女 11 例，年龄 5 - 33岁，出 生时即有，均在颜面部伴有毛发，随年龄增长而逐渐长大。 2 例 黑色素痣出现疼痛、瘙痒及破溃。术后均做病理检查， 7 例为皮 内痣，2例为交界痣，15例为混合痣；面积最大14cm^ 8cm,面 积最小约4cm^ 2cm。头皮扩张1例，面部扩张19例，胸三角扩 张1 例，胸三角+额部扩张 1 例；上臂内侧+额部扩张 1 例，上臂 内侧+面部扩张1例；扩张器容量50?300ml，扩张时间为2?3.5 个月，注水量 70?500ml。 1.2 手术方法 1.2.1 扩张设计： 应用扩张皮瓣修复黑色素痣切除术后的皮 肤软组织缺损成功与否， 术前精细的设计对缺损修复后的效果很 关键。根据病变大小和周围正常组织的两的多少， 选择在病变周 围扩张或联合其它他部位扩张。 包括供区的正确选