中国修复重建外科杂志

中国修复重建外科杂志

游离股前外侧 Kiss 皮瓣修复巨大头皮恶性肿瘤术后缺损

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目的总结游离股前外侧 Kiss 皮瓣修复巨大头皮恶性肿瘤术后缺损的疗效。方法2012 年 12 月—2016 年 12 月,收治巨大头皮恶性肿瘤患者 18 例。男 16 例,女 2 例;年龄 43~62 岁,平均 52.6 岁。鳞状细胞癌 17 例,隆突性纤维肉瘤 1 例。病程 3 个月~6 年,中位时间 22.1 个月。术中彻底切除肿瘤后,头皮软组织缺损范围为 15 cm×10 cm~17 cm×12 cm;2 例颅骨受累者切除全层颅骨后,缺损面积分别为 10 cm×8 cm、12 cm×10 cm。制备游离股前外侧 Kiss 皮瓣修复创面,皮瓣切取范围为 15 cm×6 cm~20 cm×8 cm;钛网修复颅骨缺损。供区直接拉拢缝合。结果术后皮瓣顺利成活,创面 Ⅰ 期愈合;供区切口均 Ⅰ 期愈合。1 例因局部复发侵犯颅内于术后 5 个月死亡,其余患者均无局部复发。患者均获随访,随访时间 6 个月~4 年,平均 26.6 个月。术后皮瓣外观较满意,随访期内无破溃发生。供区切口遗留线性瘢痕,未遗留明显功能障碍。结论游离股前外侧 Kiss 皮瓣可修复巨大头皮恶性肿瘤切除术后缺损,同时供区能直接拉拢缝合,避免因植皮产生第 2 供区。

ObjectiveTo investigate the effectiveness of free anterolateral thigh Kiss flap in repair of large scalp defect after malignant tumor resection.MethodsBetween December 2012 and December 2016, 18 patients with large scalp defect after malignant tumor resection were treated. There were 16 males and 2 females with an average age of 52.6 years (range, 43-62 years). There were 17 cases of squamous carcinoma and 1 case of dermatofibrilsarcoma protuberan. The size of scalp defect ranged from 15 cm×10 cm to 17 cm×12 cm after resection of tumors. The scalp defects were repaired with the free anterolateral thigh Kiss flap. And the size of flap ranged from 15 cm×6 cm to 20 cm×8 cm. The skull was completely resected in 2 cases, and repaired with Titanium mesh. The sizes of skull defects were 12 cm×10 cm and 10 cm×8 cm. The donor site was sutured directly.ResultsEighteen flaps survived with primary healing of wounds; and healing by first intention was obtained at the donor sites. One patient died because of intracranial metastasis at 5 months after operation, and no local recurrence occurred in the other 17 patients. The follow-up time ranged from 6 months to 4 years (mean, 26.6 months). The results of both appearance and function were satisfactory, without ulceration during follow-up. No obvious scar was found at donor sites and no obvious impairment was observed after harvesting free anterolateral thigh flap.ConclusionLarge scalp defects after malignant tumor resection can be effectively repaired by free anterolateral thigh Kiss flap. The donor site can be sutured directly, without skin grafting, thus avoiding the secondary donor site.

关键词: Kiss皮瓣; 游离股前外侧皮瓣; 头皮恶性肿瘤; 创面修复

Key words: Kiss flap; free anterolateral thigh flap; scalp malignant tumor; wound repair

引用本文: 左良, 喻建军, 周晓, 戴捷, 田皞, 单振锋, 胡杰, 谌星, 王鸿涵, 蔡旭, 高水超. 游离股前外侧 Kiss 皮瓣修复巨大头皮恶性肿瘤术后缺损. 中国修复重建外科杂志, 2018, 32(3): 346-349. doi: 10.7507/1002-1892.201711046 复制

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