摘要目的:观察背阔肌肌皮瓣和股前外侧皮瓣游离移植修复头皮鳞状细胞癌(鳞癌)切除后创面的效果，探讨两种皮瓣的适应证。方法:回顾性分析2013年6月至2019年5月昆明医科大学第二附属医院整形外科收治的头皮鳞癌患者的临床资料，所有患者经CT检查，未见癌转移，未合并高血压、糖尿病等全身性疾病，无血管疾病，实施肿瘤扩大切除后创面采用背阔肌肌皮瓣或股前外侧皮瓣游离移植修复。对2种皮瓣的术中血管变异情况，吻合血管直径，血管蒂的长度，皮瓣切取面积、切取时间，吻合血管时间，手术时间，供区和受区并发症发生情况进行测量或记录。结果:共纳入21例病例，男14例，女7例，年龄12～61岁。其中11例采用背阔肌肌皮瓣游离移植修复，10例用股前外侧皮瓣游离移植修复。随访1～2年，21例皮瓣全部成活。背阔肌肌皮瓣组无血管变异病例，而股前外侧皮瓣组有2例血管变异。背阔肌肌皮瓣组吻合动脉血管直径为(2.14±0.09) mm,静脉为(2.49±0.10) mm；血管蒂的长度为(6.14±0.28) cm；皮瓣切取面积(135.0±20.8) cm 2、切取时间(114.8±3.0) min；吻合血管时间(20.8±0.8) min；手术时间(6.5±0.2) h。股前外侧皮瓣组吻合动脉血管直径为(2.15±0.14) mm，静脉为(2.45±0.15) mm；血管蒂的长度(6.80±0.31) cm；皮瓣切取面积(159.9±16.4) cm 2、切取时间(119.8±3.6) min；吻合血管时间(21.5±0.9) min;手术时间(6.9±0.2) h。2种皮瓣手术中各项指标无明显差别。背阔肌肌皮瓣组供区总体并发症发生(7例)较股前外侧皮瓣组(4例)多；受区总体并发症发生(1例)较股前外侧皮瓣组(2例)少。 结论:背阔肌肌皮瓣和股前外侧皮瓣修复头皮鳞癌切除后创面均能取得良好效果。背阔肌肌皮瓣血管恒定，手术相对简单、风险低，更适合初学者；股前外侧皮瓣较薄，供区并发症发生少，患者易接受，并可在仰卧位下完成手术操作，更适合老年患者。

abstractsObjective:To observe the efficacy of free transplantation of latissimus dorsi musculocutaneous flap and anterolateral femoral skin flap in repairing the wound after the resection of the scalp squamous cell carcinoma, and to explore the indications of these two skin flaps.Methods:The clinical data of patients with scalp squamous cell carcinoma admitted to the Plastic Surgery Department of the Second Affiliated Hospital of Kunming Medical University from June 2013 to May 2019 were analyzed retrospectively. All patients showed no cancer metastasis examined with CT. None of the patients had systemic diseases such as hypertension, diabetes, vascular disease. The wounds were repaired with free transplantation of latissimus dorsi myocutaneous flaps and anterolateral thigh flaps after extensive tumor resection. The intraoperative vascular variation, the diameter of the anastomosed blood vessel, the length of the vascular pedicle, the flap size, the time of harvesting the flap, the time for anastomosis, the operation time, and the incidences of complications at the donor site and recipient site were measured or recorded in both groups.Results:A total of 21 cases were included, including 14 males and 7 females, aged from 12 to 61 years. Eleven cases were repaired with the latissimus dorsi musculocutaneous flap, and 10 cases with the anterolateral thigh flap. All the 21 flaps survived during the 1 to 2 years follow-up. No vascular variation was found in the latissimus dorsi myocutaneous flap group, whereas 2 cases of vascular variation were found in the anterolateral thigh flap. In the latissimus dorsi myocutaneous flap group, the anastomotic vessel diameter was (2.14±0.09) mm for the artery and (2.49±0.10) mm for the vein. The vascular pedicle length was (6.14±0.28) cm, and the size of the flap was (135.0±20.8) cm 2, the harvesting time was (114.8±3.0) min, the vascular anastomosis time was (20.8±0.8) min, and the operation time was (6.5±0.2) h. In the anterolateral thigh flap group, the anastomotic vessel diameter was (2.15±0.14) mm for the artery and (2.45±0.15) mm for the vein. The vascular pedicle length was (6.80±0.31) cm, and the size of the flap was (159.9±16.4) cm 2, the harvesting time was (119.8±3.6) min, the vascular anastomosis time was (21.5±0.9) min, and the operation time was (6.9±0.2) h. There was no significant difference between the two kinds of flaps in the above parameter. The incidence of total complications at the donor site was higher in the latissimus dorsi myocutaneous flap group (7 cases) than that in the anterolateral thigh flap group (4 cases). The incidence of overall complications at the recipient was lower in the latissimus dorsi myocutaneous flap group (1 case) than that in the anterolateral thigh flap group (2 cases). Conclusions:Both the latissimus dorsi myocutaneous flap and the anterolateral femoral skin flap can achieve good results in repairing the wound after the resection of the scalp squamous cell carcinoma. The latissimus dorsi myocutaneous flap has a constant blood supply, and the operative technique is relatively easy and with low risk, which is more suitable for novices. The anterolateral thigh flap is thin and with fewer complications at the donor site. It is easy to be accepted by patients and can be performed in the supine position, which is more suitable for elderly patients.