面动脉穿支筋膜蒂皮瓣与任意皮瓣修复面中部皮肤肿瘤切除后缺损的疗效比较

宋培军; 李旭文; 李薇; 王怀谷; 霍继武; 张硕; 徐静

doi:10.16766/j.cnki.issn.1674-4152.002934

面动脉穿支筋膜蒂皮瓣与任意皮瓣修复面中部皮肤肿瘤切除后缺损的疗效比较

doi: 10.16766/j.cnki.issn.1674-4152.002934

蚌埠医学院第一附属医院整形烧伤科，安徽蚌埠 233004

基金项目:

安徽高校自然科学研究项目 KJ2019A0374

安徽高校协同创新项研究项目 GXXT-2020-021

详细信息

通讯作者:
徐静，E-mail：xj.69@163.com

中图分类号: R739.5 R622.1
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出版历程
- 收稿日期: 2022-07-30
- 网络出版日期: 2023-05-31

Comparison of the effect of facial artery perforator fasciocutaneous pedicle flap and arbitrary flap in repairing the defect of mid-facial skin tumor

Department of Plastic and Burn, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨面中部皮肤肿瘤切除后采用面动脉穿支筋膜蒂皮瓣修复缺损的临床应用价值。方法选取2019年1月-2021年12月于蚌埠医学院第一附属医院整形烧伤科治疗的40例面中部皮肤肿瘤患者, 根据术中切除肿瘤后遗留创面的大小及位置分为观察组和对照组, 每组各20例, 观察组行面动脉穿支筋膜蒂皮瓣修复术, 而对照组行传统皮瓣修复术, 比较2组患者皮瓣修复后皮瓣的色泽评分、美观度评分、功能评分、术后瘢痕宽度、瘢痕弹性、瘢痕的平整度、瘢痕颜色以及术后6个月患者的效果满意度。结果观察组患者术后6个月在皮瓣的色泽评价(7.54±0.17)、美观评价(7.85±1.17)以及功能评价(8.20±0.89)评分方面均高于对照组患者术后6个月在皮瓣的色泽评价(4.85±1.73)、美观评价(5.23±1.50)以及功能评价(6.00±0.93), 均P < 0.05;观察组患者在瘢痕宽度(0.40±0.13)、瘢痕弹性(0.33±0.12)以及瘢痕平整度(0.24±0.09)以及瘢痕颜色评分(0.20±0.06)方面低于对照组在瘢痕宽度(0.58±0.18)、瘢痕弹性(0.57±0.13)、瘢痕平整度(0.38±0.16)以及瘢痕颜色评分(0.36±0.08);观察组的总体满意度(95%)高于对照组(65%); 差异均有统计学意义(P < 0.05)。结论在面部皮肤肿瘤术后组织缺损皮瓣修复手术中, 相较于传统的任意皮瓣修复术, 面动脉穿支筋膜蒂皮瓣修复术可使患者在术后外形及功能方面获得更大的满意度, 具有较高的临床应用价值。
- 面动脉穿支筋膜蒂皮瓣 /
- 肿瘤 /
- 组织缺损
Abstract: Objective To investigate the clinical application value of using facial artery perforator fasciocutaneous pedicle flap to repair defects after resection of mid-facial skin tumors. Methods A total of 40 patients with mid-facial skin tumors treated in the Department of Plastic Burns of the First Affiliated Hospital of Bengbu Medical College from January 2019 to December 2021 were divided into observation group and control group according to the size and location of the wounds left after intraoperative tumor resection, with 20 cases in each group.The observation group underwent facial artery perforator fasciocutaneous pedicle flap repair, while the control group underwent traditional flap repair.The color score, aesthetics score, function score, post-operative scar width, scar elasticity, and skin flap after flap repair, scar color, and patient satisfaction at 6 months post-operation were compared between the two groups. Results The color evaluation (7.54±0.17), aesthetic evaluation (7.85±1.17) and functional evaluation (8.20±0.89) of the flap in the observation group were higher than those in the control group[(4.85±1.73), (5.23±1.50) and (6.00±0.93)]6 months after surgery (P < 0.05).The scar width (0.40±0.13), scar elasticity (0.33±0.12), scar flatness (0.24±0.09) and scar color score (0.20±0.06) in the observation group were lower than those in the control group[(0.58±0.18), (0.57±0.13), (0.38±0.16) and (0.36±0.08)].The overall satisfaction in the observation group (95%) was higher than that in the control group (65%), with statistically significant (all P < 0.05). Conclusion Compared with traditional arbitrary flap repair, facial artery perforator fasciocutaneous pedicle flap repair can achieve greater satisfaction in postoperative appearance and function, and has high clinical application value.
- Facial artery perforator fasciocutaneous pedicle flap /
- Tumor /
- Tissue defect

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图 1 右鼻唇沟鳞癌术中采用面动脉穿支筋膜蒂皮瓣修复

注：A~C为术前; D~F示术中切除肿瘤、皮瓣设计以及穿支血管; G~I为术后即刻; J为术后7 d; K~L为术后12个月的随访。

Figure 1. Squamous cell carcinoma of right nasolabial groove repaired with facial artery perforated fasciocutaneous flap

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表 1 2组面中部皮肤肿瘤患者术后6个月皮瓣的色泽、美观度以及功能评价方面的比较(x±s, 分)

Table 1. Comparison of the color, beauty and function evaluation of the skin flap between the two groups of patients with mid-facial skin tumors 6 months after operation(x±s, points)

组别	例数	色泽评价	美观评价	功能评价
对照组	20	4.85±1.73	5.23±1.50	6.00±0.93
观察组	20	7.54±0.17	7.85±1.17	8.20±0.89
t值		6.921	6.159	7.643
P值		< 0.001	< 0.001	< 0.001

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表 2 2组面中部皮肤肿瘤患者术后6个月的瘢痕宽度、弹性、平整度及颜色评分的比较(x±s，分)

Table 2. Comparison of the width of scar, elasticity of scar, flatness and color scores between the two groups of patients with mid-facial skin tumors at 6 months after operation(x±s, points)

组别	例数	瘢痕宽度	瘢痕弹性	瘢痕平整度	瘢痕颜色评分
观察组	20	0.40±0.13	0.33±0.12	0.24±0.09	0.20±0.06
对照组	20	0.58±0.18	0.57±0.13	0.38±0.16	0.36±0.08
t值		3.626	6.067	3.411	7.155
P值		0.001	< 0.001	0.002	< 0.001

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表 3 2组面中部皮肤肿瘤患者术后6个月外观满意度的比较

Table 3. Comparison of appearance satisfaction between the two groups of patients with mid-facial skin tumors at 6 months after operation

组别	例数	极不满意 (例)	不满意 (例)	满意 (例)	比较满意 (例)	非常满意 (例)	总体满意度 (%)
观察组	20	0	1	6	5	8	95
对照组	20	1	6	5	4	4	65
注：2组总体满意度比较，χ²=3.906，P=0.048。

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参考文献(24)

[1]	LANG Z, ZHAO L, CHU Y. Esthetic repair of facial skin defect after resection of malignant tumor with lateral maxillocervical-island fasciocutaneous flap[J]. J Craniofac Surg, 2021, 32(4): e330-e332. doi: 10.1097/SCS.0000000000007075
[2]	VAIDYA T S, MORI S, DUSZA S W, et al. Appearance related psychosocial distress following facial skin cancer surgery using the FACE-Q Skin Cancer[J]. Arch Dermatol Res, 2019, 311(9): 691-696. doi: 10.1007/s00403-019-01957-2
[3]	刘畅, 张凯, 徐锦程, 等. 颌面部游离组织瓣移植术后血管危象发生的危险因素分析[J]. 蚌埠医学院学报, 2020, 45(10): 1414-1416. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202010027.htm LIU C, ZHANG K, XU J C, et al. Analysis of the risk factors of vascular crisis after free flap transplantation in oral and maxillofacial region[J]Journal of Bengbu Medical College, 2020, 45(10): 1414-1416. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202010027.htm
[4]	SAAD M, MATTEUCCI P. The pedicled submental flap in facial reconstruction[J]. Ann R Coll Surg Engl, 2021, 103(5): e159-e164. doi: 10.1308/rcsann.2020.7075
[5]	卫雪, 胡鹏, 周健, 等. 面动脉穿支皮瓣修复瘢痕性下睑外翻[J]. 中华整形外科杂志, 2021, 37(4): 399-404. doi: 10.3760/cma.j.cn114453-20201219-00635 WEI X, HU P, ZHOU J, et al. Facial artery perforator flap in repairing lower eyelid cicatricial ectropion[J]. Chinese Journal of Plastic Surgery, 2021, 37(4): 399-404. doi: 10.3760/cma.j.cn114453-20201219-00635
[6]	DANIALI L N, REZZADEH K, SHELL C, et al. Classification of newborn ear malformations and their treatment with the EarWell infant ear correction system[J]. Plast Reconstr Surg, 2017, 139(3): 681-691. doi: 10.1097/PRS.0000000000003150
[7]	张阳, 李小丹, 刘嘉锋. 局部皮瓣联合耳前带蒂真皮脂肪瓣矫正耳垂发育不良[J]. 中国美容整形外科杂志, 2021, 32(4): 204-205, 210. doi: 10.3969/j.issn.1673-7040.2021.04.005 ZHANG Y, LI X D, LIU J F. Local skin flap combined with anterior pedicled dermal fat flap to correct earlobe dysplasia[J]. Chinese Journal of Aesthetic and Plastic Surgery, 2021, 32(4): 204-205, 210. doi: 10.3969/j.issn.1673-7040.2021.04.005
[8]	FILIPPALIS A, JARA J, VEBTURA N, et al. A prospective study of benign fasciculation syndrome and anxiety[J]. Muscle Nerve, 2018, 58(6): 852-854. doi: 10.1002/mus.26193
[9]	李建成, 宋培军, 杨东昆, 等. 游离腓动脉双叶穿支皮瓣在晚期口咽癌术后缺损解剖重建中的临床效果[J]. 南方医科大学学报, 2020, 40(6): 814-821. https://www.cnki.com.cn/Article/CJFDTOTAL-DYJD202006008.htm LI J C, SONG P J, YANG D K, et al. Effect of double-leaf perforator free flap posterolateral calf peroneal artery on reconstruction of oropharyngeal anatomy after ablation of advanced oropharyngeal carcinoma[J]. Journal of Southern Medical University, 2020, 40(6): 814-821. https://www.cnki.com.cn/Article/CJFDTOTAL-DYJD202006008.htm
[10]	TANESE K. Diagnosis and management of basal cell carcinoma[J]. Curr Treat Options Oncol, 2019, 20(2): 13. doi: 10.1007/s11864-019-0610-0
[11]	JINNAI S, YAMAZAKI N, HIRANO Y, et al. The development of a skin cancer classification system for pigmented skin lesions using deep learning[J]. Biomolecules, 2020, 10(8): 1123. doi: 10.3390/biom10081123
[12]	LUBOV J E, CVAMMEN W, KEMP M G. The Impact of the circadian clock on skin physiology and cancer development[J]. Int J Mol, 2021, 22(11): 6112. doi: 10.3390/ijms22116112
[13]	ANDRADE M J, VAN LONKHUYZEN D R, UPTON Z, et al. Unravelling the insulin-like growth factor Ⅰ-mediated photoprotection of the skin[J]. Cytokine Growth Factor Rev, 2020, 52: 45-55. doi: 10.1016/j.cytogfr.2019.11.004
[14]	YOUSSEF M, CUDDIHY A, DARIDO C. Long-lived epidermal cancer-initiating cells[J]. Int J Mol Sci, 2017, 18(7): 1369. doi: 10.3390/ijms18071369
[15]	GORIG T, SCHNEIDER S, BREITBART E W, et al. Is the quality of skin cancer screening in Germany related to the specialization of the physician who performs it: Results of a nationwide survey among participants of skin cancer screening[J]. Photodermatol Photoimmunol Photomed, 2021 37(5): 454-460. doi: 10.1111/phpp.12681
[16]	朱伟政, 陈传俊. 游离股前外侧皮瓣在颌面部组织缺损移植重建中的应用[J]. 中华全科医学, 2022, 20(2): 202-205, 297. doi: 10.16766/j.cnki.issn.1674-4152.002312 ZHU W Z, CHEN C J. Free anterolateral thigh flap in maxillofacial tissue defect application in transplantation and reconstruction[J]. Chinese Journal of General Practice, 2022, 20(2): 202-205, 297. doi: 10.16766/j.cnki.issn.1674-4152.002312
[17]	ZHU S, LIU Y, ZANG M, et al. Facial defect reconstruction using the true scarless pre-expanded forehead flap[J]. J Craniofac Surg, 2018, 29(5): 1154-1160. doi: 10.1097/SCS.0000000000004450
[18]	PANZINI R G, MOSQUEIRO B P, ZOMPEL R R, et al. Quality-of-life and spirituality[J]. Int Rev Psychiatry, 2017, 29(3): 263-282. doi: 10.1080/09540261.2017.1285553
[19]	KEANEY T C, ANOLIK R, BRAZ A, et al. The male aesthetic patient: facial anatomy, concepts of attractiveness, and treatment patterns[J]. J Drugs Dermatol, 2018, 17(1): 19-28. http://pubmed.ncbi.nlm.nih.gov/29320584/
[20]	王志龙, 季远, 吕岩丽. 胸背动脉穿支皮瓣对手背软组织缺损的修复效果[J]. 蚌埠医学院学报, 2020, 45(9): 1204-1206. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202009018.htm WANG Z L, JI Y, LU Y L. Effect of dorsal thoracic artery perforator flap in the repair of dorsal hand soft tissue defect[J]. Journal of Bengbu Medical College, 2020, 45(9): 1204-1206. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202009018.htm
[21]	OBERMEIER K, SMOLKA W. Comparison of aesthetic outcome of different facial reconstruction techniques after resection of cutaneous squamous cell carcinoma[J]. J Craniomaxillofac Surg, 2020, 48(1): 117-121. http://www.sciencedirect.com/science/article/pii/S1010518219311473
[22]	KOZIEJ M, TRYBUS M, HOLDA M, et al. Anatomical map of the facial artery for facial reconstruction and aesthetic procedures[J]. Aesthet Surg J, 2019, 39(11): 1151-1162. http://www.onacademic.com/detail/journal_1000041616702599_c6ce.html
[23]	TANSATIT T, KENNY E, PHUMYOO T, et al. Cadaveric dissections to determine surface landmarks locating the facial artery for filler injections[J]. Aesthet Surg J, 2021, 41(6): 550-558. http://pubmed.ncbi.nlm.nih.gov/32789518/
[24]	陈亮, 陶德韬, 郭平, 等. 面动脉穿支皮瓣修复口腔癌术后软组织缺损的临床研究[J]. 皖南医学院学报, 2021, 40(4): 375-377. https://www.cnki.com.cn/Article/CJFDTOTAL-WNYX202104020.htm CHEN L, TAO D T, GUO P, et al. Clinical outcomes of reconstructing maxillofacial soft tissue defect with facial artery perforator flap following oral cancer surgery[J]. Journal of Wannan Medical College, 2021, 40(4): 375-377. https://www.cnki.com.cn/Article/CJFDTOTAL-WNYX202104020.htm