摘要
目的探讨足跟恶性黑色素瘤的切除范围及修复方法。方法 2007年7月-2009年6月,收治足跟恶性黑色素瘤15例。男9例,女6例;年龄32～71岁,平均47.2岁。其中原发初治13例,外院局部切除术后2例。病灶范围1.3cm×0.5cm～5.0cm×3.5cm,病灶厚度0.6～7.2mm。根据美国癌症联合会(AJCC)分期:ⅠA期1例,ⅠB期2例,ⅡA期3例,ⅡB期5例,ⅡC期1例,Ⅲ期3例。局部广泛切除后分别采用大小为7cm×5cm～12cm×8cm的足内侧皮瓣(5例)、足外侧皮瓣(2例)及腓肠神经营养血管逆行皮瓣(8例)进行修复;3例行淋巴结清扫术。供区植皮修复。结果术后1例足外侧皮瓣局部皮缘坏死,2例足内侧皮瓣供区出现部分植皮坏死,均经换药后愈合;其余皮瓣及植皮均成活,切口Ⅰ期愈合。术后15例均获随访,随访时间12～36个月,平均21个月。足外侧皮瓣感觉及功能恢复佳,足内侧皮瓣次之,腓肠神经营养血管逆行皮瓣较差。随访期间无局部复发;5例出现腹股沟淋巴结转移,其中1例死于肺转移。结论足跟恶性黑色素瘤行广泛切除后可获得较好局部控制率;应用局部皮瓣可修复创面,但腓肠神经营养血管逆行皮瓣的感觉恢复较差。
Objective To study the surgical resection and reconstruction methods of malignant melanoma on the heel.Methods Between July 2007 and June 2009,15 cases of malignant melanoma on the heel were treated.There were 9 males and 6 females,aged from 32 to 71 years with a mean age of 47.2 years.Of them,13 patients were initially treated,and 2 patients received repair after local excision.Tumor thickness was from 0.6 mm to 7.2 mm,and the size of the lesion was from 1.3 cm × 0.5 cm to 5.0 cm × 3.5 cm.According to the American Joint Committee on Cancer（AJCC） stage system,there were 1 case of IA,2 cases of IB,3 cases of IIA,5 cases of IIB,1 case of IIC,and 3 cases of III.Wide excision was performed in all cases.Defects were repaired by medial pedal skin flap（5 cases）,lateral pedal skin flap（2 cases）,and retrograde skin flap supplied by sural nutrition blood vessels（8 cases）,and the flap size ranged from 7 cm × 5 cm to 12 cm × 8 cm.Inguinal lymph node dissection was performed in 3 patients.Wounds of donor site were repaired by skin graft.Results One case had marginal necrosis of lateral pedal skin flap and 2 cases had local necrosis of medial pedal skin flap on the skin graft;the other flaps and skin grafts survived and incisions healed by first intention.All patients were followed up from 12 to 36 months（mean,21 months）.Considering the recovery of the function and sense,the best result was acquired in the lateral pedal skin flap,followed by the medial pedal skin flap,and the poor result in the retrograde skin flap supplied by sural nutrition blood vessel.No patient had local recurrence at follow-up.Five patients had inguinal lymph node metastasis,and 1 patient died of lung metastasis.Conclusion Wide resection can provide satisfactory local control for malignant melanoma on the heel.Local flap can cover the wound safely,but the retrograde skin flap supplied by sural nutrition blood vessel has poor sensory recovery.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第11期1350-1353,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
北京大学临床肿瘤学院暨北京市肿瘤防治研究所院内基金(08-30)~~
关键词
恶性黑色素瘤
足跟
广泛切除
局部皮瓣
修复重建
Malignant melanoma Heel Wide resection Local flap Repair and reconstruction
