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摘要: 目的 探讨改良V-Y推进皮瓣在面部皮肤缺损修复中的临床应用效果。方法 38例面部皮肤肿瘤患者, 依据病理类型、病变深度, 选择个性化方案切除肿瘤。根据缺损部位、大小设计合适的V-Y推进皮瓣, 一期修复皮肤缺损。其中经典皮下蒂V-Y推进皮瓣9例, 改良皮下蒂V-Y推进皮瓣24例, 穿支V-Y推进皮瓣5例。结果 38例患者中, 34例一期愈合, 2例皮瓣边缘部分坏死, 局部修剪后换药愈合; 局部感染2例, 均经过短期换药后愈合。术后发生轻度睑外翻2例, 口角移位1例。术后随访6~36个月, 功能、外形恢复良好, 1例局部复发, 3例出现腮腺区淋巴结转移, 再次行手术切除并补充放疗。结论 V-Y推进皮瓣经过改良设计, 扩大了面部缺损修复范围, 同时可获得良好的外形、功能的修复效果。Abstract: Objective To investigate the clinical effect of modified V-Y advancement flap for reconstruction of facial skin defect.Methods Thirty-eight patients with facial skin tumors underwent individual tumor resection according to pathological type and lesion depth. Based on the defect site and size, appropriate V-Y advancement flap was designed to reconstruct the skin defect in one stage. There were 9 cases of classic subcutaneous tissue pedicle V-Y advancement flap, 24 cases of modified subcutaneous tissue pedicle V-Y advancement flap and 5 cases of perforated V-Y advancement flap in our study.Results Among the 38 patients, 34 cases had primary healing. Two cases developed necrosis at the edge of the flap and healed after debridement. Local infection occurred in 2 cases, which healed after short-term dressing change. Postoperative mild eyelid ectropion occurred in 2 cases and oral horn displacement in 1 case. The patients were followed up for 6-36 months postoperatively, and the function and appearance recovered well. One case had local recurrence and 3 cases had parotid lymph node metastasis, which were removed again and supplemented with radiotherapy.Conclusion The improved design of V-Y advancement flap can enlarge the scope of facial defect reconstruction, and achieve good appearance and function.
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图 1 两种经典皮下蒂型V-Y推进皮瓣 1a：面下部缺损及颌下区V-Y皮瓣；1b：直接推进修复，外观平整；1c：面后部缺损及颌下区V-Y皮瓣；1d：皮肤松弛，推进修复后外耳无移位、畸形； 图 2 改良皮下蒂型V-Y推进皮瓣 2a：面中部基底细胞癌；2b：面中部缺损及V-Y皮瓣(皮肤延展性差，皮瓣推进量小)；2c改良皮下蒂；2d：推进后无张力修复缺损； 图 3 携带知名动脉(面动脉)的V-Y推进皮瓣 3a：鼻唇沟皮肤鳞状细胞癌；3b：鼻背、面中部缺损；3c：皮瓣轻松推进至缺损区；3d：缝合后鼻、下睑基本无移位； 图 4 穿支V-Y推进皮瓣修复额部继发性缺损 4a：额-鼻部鳞状细胞癌；4b：额、鼻背、眼睑缺损；4c：右滑车上动脉皮瓣；4d：滑车上动脉皮瓣修复额鼻眼睑缺损、形成额部继发性缺损；4e：左颞浅动脉穿支V-Y推进皮瓣及其血管蒂；4f：双侧V-Y皮瓣；4g：双侧V-Y皮瓣修复额部继发性缺损；4h：术后半年外观； 图 5 携带面动脉的V-Y推进皮瓣联合鼻唇沟皮瓣修复复杂缺损 5a：左鼻翼、鼻背、鼻唇沟复合缺损；5b：鼻唇沟皮瓣(折叠)及V-Y皮瓣；5c：分别修复鼻翼、鼻唇沟缺损；5d：半年后外观； 图 6 穿支V-Y推进皮瓣联合易位皮瓣修复额部缺损 6a：额部鳞状细胞癌；6b：左颞浅动脉穿支V-Y推进皮瓣；6c：切取易位皮瓣；6d：两瓣联合修复额部缺损。
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