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目的总结1例应用耳后瓣联合多瓣修复右颞部恶性肿瘤组织大缺损的效果。方法 2016年1月收治1例右颞部肿物男性患者,75岁;肿物大小约为4 cm×4 cm。术中病理示鳞状细胞癌。术中行扩大切除术、面神经解剖术,肿物切除后组织缺损范围为8 cm×8 cm。于缺损部邻近组织设计制备耳后瓣、鼻唇沟瓣、颊瓣、颈胸皮瓣,大小分别约为4 cm×3 cm、4 cm×2 cm、4 cm×3 cm、8 cm×4 cm,联合修复创面。结果术后皮瓣血运良好,均成活,供受区创面均Ⅰ期愈合。术后1个月内因皮瓣张力过大,右口角向上偏移;外眦受牵拉外移,致右眼裂变小。术后3个月随访,右侧口角位置基本恢复正常,眼周稍肿胀,眼裂稍小,皮瓣色泽、质地均良好。术后4个月面部外形对称,表情自然协调正常,患者满意。结论耳后瓣联合多瓣修复颞部组织大缺损效果良好,手术方法较简便,尤其适合老年患者。
Objective To summarize the effect of applying auricular flap combined with flap to repair large defect of right temporal malignant tumor. Methods One male patient with right temporal tumor was admitted in January 2016, aged 75 years. The size of the tumor was about 4 cm × 4 cm. Intraoperative pathology showed squamous cell carcinoma. Surgery underwent expansive resection, facial nerve anatomy, tumor resection tissue defect range of 8 cm × 8 cm. The auricles, nasolabial foramina, buccal flaps, neck and thoracic flaps were designed and prepared in the tissue adjacent to the defect. The sizes of the ear, the flap and the neck and chest flap were 4 cm × 3 cm, 4 cm × 2 cm, 4 cm × 3 cm, 8 cm × 4 cm, joint repair wounds. Results The blood supply of the flaps was good and all survived for the wound healing in the first stage. Within 1 month after operation, the tension of the flap was shifted upward due to the excessive tension of the flap; After 3 months of follow-up, the position of the right side of the mouth back to normal, slightly swollen eyes, slightly smaller eyes, flap color, texture are good. 4 months after the facial shape symmetry, natural expression of normal coordination, patient satisfaction. Conclusions The combination of ear flap and multi flap for the repair of large temporal tissue defect has a good effect. The surgical method is simple and convenient, especially for elderly patients.