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目的总结采用改良带蒂展肌肌皮瓣移位修复足跟部皮肤恶性黑色素瘤扩大切除后软组织缺损的疗效。方法 2008年2月-2011年6月,收治5例足跟部皮肤恶性黑色素瘤患者。男2例,女3例;年龄35～69岁,平均49岁。病程2～10年。足跟原发肿瘤范围为3 cm×2 cm～5 cm×4 cm,3例伴破溃。4例肿瘤扩大切除后缺损范围为6 cm×6 cm～8 cm×6 cm,1例因伴卫星灶缺损达13 cm×12 cm;采用大小为6 cm×6 cm～11 cm×9 cm改良带蒂展肌肌皮瓣移位修复缺损,不足部分取中厚皮片修复。供区采用腹股沟中厚皮片修复。结果术后肌皮瓣及供受区植皮均成活,创面Ⅰ期愈合。2例腹股沟切口发生淋巴漏,经换药和清创术后愈合。5例均获随访,随访时间12～24个月。足跟部皮肤无破裂和磨损,外形丰满、弹性良好,肌皮瓣痛、温觉和耐磨性能良好。足踝伸屈功能正常,恢复负重功能,无肿瘤生长。足部切取肌皮瓣处凹陷明显,第1、2、3趾底感觉减退、麻木。结论改良带蒂展肌肌皮瓣修复足跟部皮肤恶性黑色素瘤切除后缺损可获得丰满、耐磨和弹性好的外观。
Objective To summarize the curative effect of using modified pedicled myocutaneous muscle flap to repair soft tissue defect after resection of malignant melanoma in the heel. Methods From February 2008 to June 2011, 5 patients with malignant melanoma of the heel were treated. 2 males and 3 females; aged 35 to 69 years, mean 49 years. Course of 2 to 10 years. Hematoma primary tumor range of 3 cm × 2 cm ~ 5 cm × 4 cm, 3 cases with ulceration. The size of the defect was 6 cm × 6 cm ~ 8 cm × 6 cm in 4 cases, and 13 cm × 12 cm in 1 case due to satellite defect. The size of the defect was 6 cm × 6 cm ~ 11 cm × 9 cm Pedunculated brachii myocutaneous flap displacement to repair defects, insufficient part to take the thick skin repair. For the area with groin thick skin repair. Results The myocutaneous flap and donor skin grafting survived. The wound healed in the first stage. Two cases of inguinal incision lymphatic leakage, after dressing and debridement healed. All patients were followed up for 12-24 months. Heel and skin without rupture and wear, plump shape, good elasticity, myocutaneous flap pain, warm feeling and good wear resistance. Ankle flexion and extension normal function, restore weight function, no tumor growth. The excision of myocutaneous flap at foot was obvious, the first, second and third bottom of the foot felt hypnosis, numbness. Conclusions The modified pedicled myocutaneousis myocutaneous flap can be used to repair the defect of excised melanoma in the heel skin and obtain a plump, wear-resistant and elastic appearance.