头面部皮肤恶性肿瘤手术切除及组织缺损修复探析［摘要］目的:探讨头面部皮肤恶性肿瘤手术切除和组织缺损修复的临床经验。方法:1991年1月~2006年1月共收治56例头面部皮肤恶性肿瘤患者，术后组织缺损根据患者情况分别采用原位缝合12例、皮片移植8例、局部皮瓣25例、邻位皮瓣9例和远位皮瓣2例修复。结果:本组56例，除1例皮瓣远端表皮坏死，经换药治疗伤口II期愈合外，其余皮瓣及植皮均成活,供区均I期愈合。38例患者获随访1〜6年,1例复发;复发病例为植皮治疗的鳞状细胞癌患者于术后1年复发,经再次手术扩大切除后采用皮瓣移位修复，随访3年未再复发;随访患者均存活良好，外形及功能满意。结论:头面部皮肤恶性肿瘤早期诊断、彻底切除、及时修复、杜绝复发及取得良好的外观和功能效果是治疗的关键所在。修复方法根据患者具体情况和头面部美学单位或亚单位原理遵循由简至繁的原则,尽可能兼顾缺损区域外形和功能的恢复。［关键词］头面部;皮肤恶性肿瘤;修复;皮瓣;植皮［中图分类号］R622［文献标识码］A［文章编■t]1008-6455(2010)01-0001-04ReconstructionofthetissuedefectsafterexcisionofskinmalignanciesintheheadandfaceregionSONGWei-ming,WANGJia-qi,GUOXin,WANGFeng-xian,FANGLin,YUHong-min,LIUXiao-wei(DepartmentofCervicofacialPlasticandReconstruc-tiveSurgery,PlasticSurgeryHospital,ChineseAcademyofMedicalScience,PekingUnionMedicalCollege,Beijing100144,China)Abstract:ObjectiveToinvestigatetheclinicalexperi-encesofreconstructionofthetissuedefectsafterresectionofskincancersintheheadandfaceregion.MethodsFromJanuary1991toJanuary2006,56patientswithskinmalig-nanciesintheheadandfaceregionweretreatedwithdiffer-entsurgicaltechniques.Accordingtothecharacteristicsofthepatients,thetissuedefectswererepairedwithprimaryclosurein12cases,freeskingraftingin8cases,localskinflapin25cases,ortho-positionskinflapin9cases,anddis-tantskinflapin2cases.ResultsAmong56cases,55skinflapsandskingraftingssurvivedandincisionhealedbyfirstintention;1flapnecrosedattheepidermisofthedistalendandhealedbysecondaryintentionafterdressingchanges・Allofthedonorsiteshealedbyfirstintention.38patientswerefollowedupfor1to6years.Amongthesecaseswithfollowup,1caseofsquamouscellcarcinomawithskingraft-ingoccurredrecurrenceafter1yearrespectivelyandwasgivenradicalresectionandwasreconstructedwithskinflapagain,theothercasesoccurrednorecurrence・Allofpa-tientswithfollowupsurvivedwell.Thefunctionalandaes-theticresultsaresatisfactory.ConclusionTheskinmalignan-ciesintheheadandfaceregionshouldbediagnosisedandtreatedasearlyaspossible.Radicalresection,resistancere-currenceandsimultaneousreconstructionwiththesatisfac-toryfunctionalandaestheticresultsarecrucialfortherecon-structivesurgeonandarekeypointsofsurgicaltreatments・Basedontheaestheticunitorsubunitprinciplesintheheadandfaceregionandaccordingtothecharacteristicsofthepatients,selectionofthereconstructivemethodmustcomplywiththealgorithmfromsimpletocomplex.Achievementofthefunctionalandaestheticoutcomeshouldbeconsidered,ifpossible.Keywords:headandfaceregion;skinmalignancies;reconstruction;flap;skingrafting头面部皮肤恶性肿瘤以基底细胞癌和鳞状细胞癌较为常见［□肿瘤不但影响美观，而且危害人的生命健康。手术治疗在切除肿瘤、修复缺损的同时既要考虑手术切除的彻底性,减少复发;又要考虑组织缺损的修复问题，最大限度地保留或恢复头面部外观和功能［2-3］o1991年1月~2006年1月我们共收治56例头面部皮肤恶性肿瘤患者，根据患者自身情况和头面部美学单位或亚单位原则，采用不同手术治疗方法，获得了比较满意的治疗效果,现报道如下。1资料和方法1.1临床资料1991年1月~2006年1月共收治56例头面部皮肤恶性肿瘤患者，男性38...