扩大的带蒂足母展肌肌皮瓣修复恶性黑色素瘤切除术后软组织缺损

摘要

目的：评价扩大的带蒂足母展肌肌皮瓣修复厚于4 mm 的足跟部皮肤恶性黑色素瘤切除后软组织缺损的方法和疗效。方法收治6例厚度大于4 mm 的肿块型足跟部皮肤恶性黑色素瘤患者，男4例，女2例，年龄46~83岁，平均63岁，病程2~10年；足跟原发瘤和卫星灶范围为5 cm ×4 cm ~8 cm ×7 cm，伴破溃；肿瘤厚度：8~45 mm，平均21.1 mm；肿瘤扩大2 cm 切除后缺损范围为9 cm ×8 cm ~13 cm ×12 cm，采用大小为9 cm ×9 cm ~11 cm ×10 cm 的扩大的带蒂足母展肌肌皮瓣移位修复足跟负重部位缺损，供区及足跟内外两侧面非负重区缺损取同侧下腹壁或对侧腹股沟区中厚皮片覆盖修复。结果术后肌皮瓣及供区植皮均成活，创面愈合良好，足部外形及功能满意。2例前足底内侧半感觉丧失，4例保留1~2支较粗足底内侧感觉神经者前足底内侧感觉减退。结论扩大的带蒂足母展肌肌皮瓣适宜修复厚于4 mm 的足部恶性黑色素瘤术中较大缺损，小腿皮肤有移行瘤可能者可选用此肌皮瓣。%Objective To evaluate the effectiveness of ampliative pedicled abductor-hallucis-myocutaneous flap to repair postoperative defect of the heel malignant melanoma in thickness more than 4 mm. Methods There were 6 patients with the mass type of heel skin malignant melanoma in thickness more than 4 mm,including 4 males and 2 females. Their age range from 46 to 83 years,with an average of 63 years old. And the course of disease ranged from 2 to 10 years;The area of primary tumor and its satellite nodules on heels were from 5 cm × 4 cm to 8 cm × 7 cm,all with ulceration. The maximum thickness of primary tumor range from 8 mm to 45 mm,with an average of 21. 1 mm. The area of defects were from 9 cm × 8 cm to 13 cm × 12 cm after wide exsection to expand 2 cm for these tumor. We repaired the defects of weightbearing area on heels with amplia-tive pedicled abductor-hallucis-myocutaneous flap about the size of 9 cm × 9 cm to 11 cm × 10 cm,and the remaining defects in the donor site and ambilateral non-weight bearing area on heels were repaired by split-thickness skin grafts from the homolater-al lower abdominal wall or the contralateral inguinal region. Results These musculocutaneous flaps and skin grafts survived,the wound healed well. The function and shape of the heels were satisfactory. The feeling of plantar medial halves were lost in 2 pa-tients,the medial forefoot plantar were hypoesthesia in 4 patients with 1 ~2 branches of medial plantar sensory nerve to be pre-served. Conclusion The ampliative pedicled abductor-hallucis-myocutaneous flap is suitable to repair the larger postoperative defect of heel malignant melanoma in thickness more than 4 mm,and may be chosen if metastases might ensconce in lower leg.