摘要目的 探讨自由式穿支皮瓣在鼻肿瘤切除后缺损修复中的应用价值.方法 依据术前多普勒检测结果,设计以自由式穿支血管为蒂的V-Y推进皮瓣等多种皮瓣,转移修复鼻肿瘤切除后创面.术后1个月,根据病理结果行放疗,评价复发率.结果 31例患者皮瓣全部成活,29例伤口一期愈合.1例术后出血,皮瓣张力较大、表皮形成水疱,抽出疱液、经换药愈合.1例静脉回流不畅,皮瓣瘀血,针刺放血处理后,延迟愈合.23例术后行辅助放射治疗,随访6个月至5年,修复后局部外形及色泽均满意,肿瘤无复发.结论 自由式穿支皮瓣修复鼻肿瘤扩大切除后创面,既利于肿瘤术后及时有效放疗,又有较好的外观.

abstractsObjective To study the value of free-style perforator flap in repairing nasal defects after tumor resection.Methods On the basis of the guidance of free-style perforator flap design concept and the foundation of vascular localization by Doppler based on the ultrasonic echo intensity,combined with nasal beauty subunits,we designed free-style perforator flap in different forms such as V-Y advancing flap,rotating flap,and propeller flap,which had with free-style perforator in pedicle all.We transplanted the flaps to repair nasal defects after tumor resection.The area of the flaps was between 2 cm x 1.0 cm and 8.0 cm x 5.0 cm,and the diameter of the perforate vessel in the pedicle of flap was between 0.3 mm-3 mm,and some of the pedicles were composed of perforate vessel tube bundle.In order to reduce recurrence rate,the radiotherapy was performed according to the pathology in 1 month after surgery.Results In 31 cases of this group,29 cases were performed and the postoperative shape was good.1 case appeared postoperative hemorrhage,and the epidermis of flap formed blister because of greater tension,and the patient healed 10 days later after extraction the bubble fluid and changing medicine.The flap of 1 case was silted because the venous was blocked,and the acupuncture was treated,and then the flap got delayed union.23 cases received adjuvant radio therapy after surgery and fellowed up from 6 months to 5 years,showing that local profile and color were satisfacfory without tumor recurrence.Conclusions It is worthy of clinical promotion to designing freetype perforator flap and to repair defect after extensive nasal tumor resection on the basis of beauty subunits in nasal and vascular anatomy,which can not only reduce the recurrence rate by postoperative radiotherapy in time,but also realize better cosmetic requirements.