接力皮瓣修复耳廓及供瓣区皮肤软组织缺损
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摘要
目的探讨接力皮瓣修复耳廓及供瓣区皮肤软组织缺损的疗效。方法 2014年5月—2016年1月,收治10例耳廓皮肤肿瘤患者。男4例,女6例;年龄21～69岁,平均35岁。基底细胞癌2例,色素痣3例,乳头状瘤4例,鲍文病1例。术中切除肿物后遗留创面范围为1.1 cm×1.0 cm～2.3 cm×1.7 cm。用颞浅动脉耳后穿支皮瓣修复耳廓缺损,皮瓣切取范围为1.5 cm×1.4 cm～2.8 cm×2.0 cm;使用耳后动脉穿支顺行推进皮瓣修复第1供瓣区,皮瓣切取范围为4.0 cm×2.0 cm～7.5 cm×3.0 cm,第2供瓣区创面直接拉拢缝合。结果术后皮瓣均顺利成活,供、受区创面均Ⅰ期愈合。患者均获随访,随访时间10～28个月,平均14.2个月。重建耳廓形态满意,肿瘤无复发。皮瓣外形、色泽、质地和厚度与受区基本一致,瘢痕不明显,无牵拉畸形,感觉无明显异常。结论接力皮瓣血供可靠,手术操作简便,供区隐蔽,是修复耳廓及供瓣区皮肤软组织缺损的较好选择。
Objective To investigate the effectiveness of relay flap on repairing skin and soft tissue defect of auricle and donor site. Methods Between May 2014 and January 2016, 10 patients with auricular tumor were repaired by relay flap. There were 4 males and 6 females with an average age of 35 years(range, 21-69 years). There were basal cell carcinoma in 2 cases, pigmented nevus in 3 cases, papilloma in 4 cases, and Bowen's disease in 1 case. The size of the residual wound after tumor resection ranged from 1.1 cm×1.0 cm to 2.3 cm×1.7 cm. The superficial temporal artery posterior auricular perforator flap was used to repair the auricle defect wound. The size of flap ranged from 1.5 cm×1.4 cm to 2.8 cm×2.0 cm. The first donor site was repaired with the posterior auricular artery perforator propulsive flap. The size of flap ranged from 4.0 cm×2.0 cm to 7.5 cm×3.0 cm. The wound of the second donor site was sutured directly at the first stage. Results All the flaps survived. The donor and recipient sites healed by first intention. The patients were followed up 10-28 months, with an average of 14.2 months. The appearance of reconstructed auricle was satisfactory, and the tumor had no recurrence. The appearance, color, texture, and thickness of the flaps were basically consistent with the recipient site, without obvious scar, traction deformity, or obvious abnormal sensation. Conclusion The relay flap has advantages of reliable blood supply, the simple operation method, the concealed donor site, which is a good choice to repair the skin and soft tissue defect of auricle and donor site.
Objective To investigate the effectiveness of relay flap on repairing skin and soft tissue defect of auricle and donor site. Methods Between May 2014 and January 2016, 10 patients with auricular tumor were repaired by relay flap. There were 4 males and 6 females with an average age of 35 years(range, 21-69 years). There were basal cell carcinoma in 2 cases, pigmented nevus in 3 cases, papilloma in 4 cases, and Bowen's disease in 1 case. The size of the residual wound after tumor resection ranged from 1.1 cm×1.0 cm to 2.3 cm×1.7 cm. The superficial temporal artery posterior auricular perforator flap was used to repair the auricle defect wound. The size of flap ranged from 1.5 cm×1.4 cm to 2.8 cm×2.0 cm. The first donor site was repaired with the posterior auricular artery perforator propulsive flap. The size of flap ranged from 4.0 cm×2.0 cm to 7.5 cm×3.0 cm. The wound of the second donor site was sutured directly at the first stage. Results All the flaps survived. The donor and recipient sites healed by first intention. The patients were followed up 10-28 months, with an average of 14.2 months. The appearance of reconstructed auricle was satisfactory, and the tumor had no recurrence. The appearance, color, texture, and thickness of the flaps were basically consistent with the recipient site, without obvious scar, traction deformity, or obvious abnormal sensation. Conclusion The relay flap has advantages of reliable blood supply, the simple operation method, the concealed donor site, which is a good choice to repair the skin and soft tissue defect of auricle and donor site.
引文
1陈召阳,罗春材,尚骁,等.数字化技术在耳廓再造中的应用进展.中国修复重建外科杂志, 2017, 31(9):1135-1140.
2Hénoux M, Espitalier F, Hamel A, et al. Vascular supply of the auricle:anatomical study and applications to external ear reconstruction. Dermatol Surg, 2017, 43(1):87-97.
3姚琳莉,喻璐,张碧波,等.耳廓良性肿物切除及缺损修复92例临床分析.中华耳科学杂志, 2018, 16(5):676-680.
4罗静,苏庚,袁群芳.带蒂皮瓣修复外耳道缺损疗效分析.中国美容医学, 2018, 27(1):71-73.
5唐举玉,汪华侨, Hallock GG,等.关注皮瓣供区问题-减少皮瓣供区损害专家共识.中华显微外科杂志, 2018, 41(1):3-5.
6郭佩佩,蒋海越.获得性耳廓缺损的外科治疗进展.中国修复重建外科杂志, 2018, 32(9):1218-1222.
7Shokrollahi K, Taylor JP, Le Roux CM, et al. The postauricular fascia:classification, anatomy, and potential surgical applications.Ann Plast Surg, 2014, 73(1):92-97.
8杨大平,韩雪峰,郭铁芳.耳后皮瓣血管的显微外科解剖学基础.中国临床解剖学杂志, 2002, 30(3):166-168.
9 黄淑新,姜宪,崔哲洙.耳后带蒂皮瓣在修复耳甲腔皮肤缺损中的应用.中国耳鼻咽喉颅底外科杂志, 2018, 24(2):173-175.
10常树森,何春念,金文虎,等.股前外侧皮瓣的供区并发症.中华显微外科杂志, 2018, 41(1):101-104.
11Zhang YZ, Li YL, Yang C, et al. Reconstruction of the postauricular defects using retroauricular artery perforator-based island flaps:anatomical study and clinical report. Medicine, 2016, 95(37):e4853.
12张林,赵宇,李小静,等.耳后皮瓣在外耳部分缺损的亚单位分区精准修复.中华整形外科杂志, 2018, 34(8):625-629.
13阳俊杰,邓安春.耳后区不同带蒂皮瓣修复外耳道及耳廓皮肤缺损的临床疗效观察.重庆医学, 2016, 45(1):108-110.
14Al-Qattan MM, Al-Arfaj N. The postauricular fasciocutaneous flap with an adipofascial extension:A case report. Int J Surg Case Rep,2016, 29:165-167.
15丁志琴,何丕.两种带蒂皮瓣修复对耳郭、外耳道缺损的临床效果及手术方法分析.中国美容整形外科杂志, 2017, 28(8):492-494.
16Sel?uk CT, Durgun M, Bozkurt M, et al. The reconstruction of fullthickness ear defects including the helix using the superior pedicle postauricular chondrocutaneous flap. Ann Plast Surg, 2014, 72(2):159-163.
17王江允,杨琳琳,陈春丽,等.颞浅筋膜瓣结合头皮刃厚皮片移植修复耳廓再造术后软骨支架外露.中国美容医学, 2017, 26(12):34-36.
18 Hu J, Zhang Q, Zhang Y, et al. Partial helix defect repair by use of postauricular advancement flap combined with ipsilateral conchal cartilage graft. J Plast Reconstr Aesthet Surg, 2014, 67(8):1045-1049.
2Hénoux M, Espitalier F, Hamel A, et al. Vascular supply of the auricle:anatomical study and applications to external ear reconstruction. Dermatol Surg, 2017, 43(1):87-97.
3姚琳莉,喻璐,张碧波,等.耳廓良性肿物切除及缺损修复92例临床分析.中华耳科学杂志, 2018, 16(5):676-680.
4罗静,苏庚,袁群芳.带蒂皮瓣修复外耳道缺损疗效分析.中国美容医学, 2018, 27(1):71-73.
5唐举玉,汪华侨, Hallock GG,等.关注皮瓣供区问题-减少皮瓣供区损害专家共识.中华显微外科杂志, 2018, 41(1):3-5.
6郭佩佩,蒋海越.获得性耳廓缺损的外科治疗进展.中国修复重建外科杂志, 2018, 32(9):1218-1222.
7Shokrollahi K, Taylor JP, Le Roux CM, et al. The postauricular fascia:classification, anatomy, and potential surgical applications.Ann Plast Surg, 2014, 73(1):92-97.
8杨大平,韩雪峰,郭铁芳.耳后皮瓣血管的显微外科解剖学基础.中国临床解剖学杂志, 2002, 30(3):166-168.
9 黄淑新,姜宪,崔哲洙.耳后带蒂皮瓣在修复耳甲腔皮肤缺损中的应用.中国耳鼻咽喉颅底外科杂志, 2018, 24(2):173-175.
10常树森,何春念,金文虎,等.股前外侧皮瓣的供区并发症.中华显微外科杂志, 2018, 41(1):101-104.
11Zhang YZ, Li YL, Yang C, et al. Reconstruction of the postauricular defects using retroauricular artery perforator-based island flaps:anatomical study and clinical report. Medicine, 2016, 95(37):e4853.
12张林,赵宇,李小静,等.耳后皮瓣在外耳部分缺损的亚单位分区精准修复.中华整形外科杂志, 2018, 34(8):625-629.
13阳俊杰,邓安春.耳后区不同带蒂皮瓣修复外耳道及耳廓皮肤缺损的临床疗效观察.重庆医学, 2016, 45(1):108-110.
14Al-Qattan MM, Al-Arfaj N. The postauricular fasciocutaneous flap with an adipofascial extension:A case report. Int J Surg Case Rep,2016, 29:165-167.
15丁志琴,何丕.两种带蒂皮瓣修复对耳郭、外耳道缺损的临床效果及手术方法分析.中国美容整形外科杂志, 2017, 28(8):492-494.
16Sel?uk CT, Durgun M, Bozkurt M, et al. The reconstruction of fullthickness ear defects including the helix using the superior pedicle postauricular chondrocutaneous flap. Ann Plast Surg, 2014, 72(2):159-163.
17王江允,杨琳琳,陈春丽,等.颞浅筋膜瓣结合头皮刃厚皮片移植修复耳廓再造术后软骨支架外露.中国美容医学, 2017, 26(12):34-36.
18 Hu J, Zhang Q, Zhang Y, et al. Partial helix defect repair by use of postauricular advancement flap combined with ipsilateral conchal cartilage graft. J Plast Reconstr Aesthet Surg, 2014, 67(8):1045-1049.