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目的探讨头面部非黑色素瘤皮肤癌扩大切除术后缺损部位的不同修复方法及效果。方法收集2002年1月—2012年12月新疆医科大学附属肿瘤医院乳腺头颈肿瘤外科收治的176例头面部皮肤癌患者的资料,根据病灶的部位和范围,行扩大切除后分别采取游离创缘后拉拢缝合(41例,拉拢缝合组)、局部皮瓣转移修复(81例,局部皮瓣组)及皮片移植(54例,皮片移植组)行一期修复缺损,比较3组术后修复效果。结果拉拢缝合组5例切口裂开,睑外翻1例;皮片移植组9例缺血感染,植皮失败后重新植皮;局部皮瓣组仅1例出现皮瓣远端缺血坏死,余全部一期成活。局部皮瓣组愈合情况优于皮片移植组及拉拢缝合组。局部皮瓣组及皮片移植组满意度优于拉拢缝合组,而局部皮瓣组与皮片移植组满意度差异无统计学意义。随访1个月~10a,3组患者均无肿瘤复发及转移。结论应根据头面部非黑色素瘤皮肤癌术后缺损的不同情况采用不同手术方法,拉拢缝合仅适用于病灶较小、局部皮肤松弛患者,对于修复较大皮肤缺损,局部皮瓣优于皮片移植及拉拢缝合。
Objective To investigate the different repair methods and effects of defect site after enlarged resection of non-melanoma skin on head and face. Methods Data of 176 patients with head and face skin cancer admitted to the Department of Breast and Neck Surgery, Cancer Hospital of Xinjiang Medical University from January 2002 to December 2012 were collected. According to the location and range of the lesion, (41 cases, suture closure group), local flap transfer repair (81 cases, local flap group) and skin grafting (54 cases, skin graft group) were performed the first stage repair defect, compared with three groups of postoperative repair effect. Results In the suture group, 5 cases of incision and eyelid eversion were found in 1 case. In the skin graft group, 9 cases of ischemic infection were found, and the skin graft failed to reepithelialize. In the local flap group, only 1 case showed flap distal necrosis and necrosis, A survival. Local skin flap healing was better than skin flap transplantation and suture closure. The satisfaction of local flap group and skin graft group was better than that of suture group, while there was no significant difference of satisfaction between local flap group and skin graft group. Follow-up 1 month ~ 10a, 3 patients had no tumor recurrence and metastasis. Conclusions Different surgical methods should be used according to the different situations of postoperative non-melanoma skin cancers in the head and face. Suture and suture is only suitable for patients with lesser lesions and partial skin dislocation. The local flap is better than the skin graft for repairing the large skin defect And draw suture.