V形切口切除头皮下肿物的临床应用经验

V形切口切除头皮下肿物的临床应用经验

孙海玮林枫郝春雨王安娜王洪一

本文来源：《中华整形外科杂志》2023年5月第39卷第5期

DOI:10. 3760 / cma.j.cn114453-20220925-00294

作者单位：北部战区总医院烧伤整形科，沈阳110016

通信作者：王洪一，Email：why1_0@163.com

引用本文

孙海玮, 林枫, 郝春雨, 等. V形切口切除头皮下肿物的临床应用经验 [J] . 中华整形外科杂志, 2023, 39(5) : 535-539. DOI: 10.3760/cma.j.cn114453-20220925-00294.

【摘要】

目的总结应用V形切口切除头皮下肿物的临床经验。

方法回顾性分析2020年8月至2021年12月北部战区总医院烧伤整形科收治的头皮下良性肿物患者的临床资料，肿物直径均大于3 cm且与周围组织粘连紧密，均应用V形切口切除肿物。术中沿设计线切开头皮、掀起V形皮瓣并完整切除肿物，自切口尖端逐针缝合至张力适中位置，将头皮瓣平铺于创面上，切除多余的头皮组织并缝合，形成Y形切口。术后对皮瓣成活、并发症、切口瘢痕、切口周围头发生长及肿物复发情况进行观察和随访。

结果共纳入20例患者，其中男12例，女8例；年龄(46.8±10.5)岁；病史(3.6±1.9)年；肿物直径(4.1±1.1) cm；皮脂腺囊肿8例，脂肪瘤5例，表皮样囊肿7例。术后18例皮瓣成活良好，2例皮瓣尖端表皮坏死，经换药后愈合。术后随访6~12个月，3例患者局部头皮感觉麻木，3~6个月好转；20例术区头皮平整，切口瘢痕无明显增生，视觉上瘢痕短，周围头发生长正常，肿物均无复发。

结论 V形切口显露肿物相对容易，可以精确切除多余皮肤，术后头皮平整度及外观较好，是与周围组织粘连紧密、剥离困难的较大头皮下肿物较好的切口选择。

【关键词】修复外科手术；头皮下肿物；V形切口；直线切口；S形切口

基金项目：国家科学自然基金青年科学基金项目（82002047）

Clinical experience of V-shaped incision for excision of scalp subcutaneous tumors

Sun Haiwei, Lin Feng, Hao Chunyu, Wang Anna, Wang Hongyi

Department of Burns and Plastic Surgery, the Northern Theater General Hospital, Shenyang 110016, China

Corresponding author: Wang Hongyi, Email: why1_0@163.com

【Abstract】

Objective To summarize the clinical experience of using V-shaped incision to excise scalp subcutaneous tumors.

Methods A retrospective analysis of the clinical data of patients with subcutaneous benign tumors admitted to the Department of Burns and Plastic Surgery of the Northern Theater General Hospital from August 2020 to December 2021 was conducted. The tumors were all above 3 cm in diameter and closely adhered to surrounding tissues, and all were removed using a V-shaped incision. During the operation, the scalp was incised along the design line, the V-shaped skin flap was lifted to affiliate the tumor removed. The incision was closed directly from the tip of "V" until the moderate tension attained. The scalp flap was spread smoothly on the wound surface, and the excess scalp tissue was removed to form a Y-shaped suture. The flap survival, complications, incision scar, hair growth around the incision and tumor recurrence were observed and followed up after operation.

Results A total of 20 cases were included, including 12 males and 8 females, with an average medical history of (3.6±1.9) years and a tumor diameter of (4.1±1.1) cm. There were 8 sebaceous cysts, 5 lipomas, and 7 epidermoid cysts. After operation, 18 flaps survived well, and 2 cases had epidermal necrosis at the tip of the flap, which healed after dressing change. During the follow-up period of 6-12 months, 3 patients experienced local scalp numbness, which improved within 3-6 months. In 20 cases, the scalp was flat, the incision scar was not hyperplastic, the scar was short visually, the surrounding hair grew normally, and no tumor recurrence happened.

Conclusion V-shaped incision is relatively easy to expose the tumor and can accurately remove excess skin. After operation, the scalp has a good flat appearance, so it is an ideal choice for large scalp subcutaneous tumors with close adhesion to the surrounding tissue.

【Key words】Reconstructive surgical procedures; Scalp subcutaneous tumors; V-shaped incision; Linear incision; S-shaped incision

Fund program: National Natural Science Foundation of China for Youth Science Fund Project（82002047）

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: This study was conducted in accordance with the Helsinki Declaration.

头皮肿物多以良性为主，其中囊肿占头皮良性肿物的50%以上，包括皮脂腺囊肿、表皮样囊肿和皮样囊肿[1]。其他常见良性肿物还包括脂肪瘤、纤维瘤、毛基质瘤(钙化囊肿)、脂溢性角化病、痣、血管瘤、疣和假性淋巴瘤等[2]。头皮下肿物切除通常采用直线和S形切口[3]。由于头皮组织致密，弹性及移动性差，且当皮下肿物生长时间较长或位于枕部、颞部等受压部位时，常与周围组织粘连紧密，术中显露及剥离较为困难，此时直线切口常需延长至肿物边界以外，导致切口变长。此外，较大肿物切除后常有皮肤冗余，直线和S形切口在去除多余皮肤时，参照性较差，难以做到精确去皮和调整头皮平整度。我们在临床实践中应用V形切口切除较大且粘连紧密的头皮下肿物，以Y形缝合技术修复创面，取得了较好的效果，现对临床经验进行总结，并对相关原理进行探讨。

一、资料与方法

(一)资料选择

回顾性分析2020年8月至2021年12月北部战区总医院烧伤整形科收治的头皮下肿物患者的临床资料。纳入标准：(1)经超声、磁共振成像(MRI)或CT检查明确头皮肿物层次位于皮下，界限清楚，考虑为良性病变；(2)肿物直径大于3 cm；(3)肿物移动性中等或略差，与周围组织粘连紧密；(4)应用V形切口切除头皮下肿物。排除标准：(1)合并糖尿病等基础疾病；(2)术区脱发；(3)瘢痕体质患者；(4)未完成随访。本研究符合赫尔辛基宣言，患者及家属对本研究知情并签署知情同意书。

(二)手术方法

术前确定并标记头皮下肿物范围，在边界标记3点，将边界分为3等份，选取1点为尖端，并与另2点连线，形成V形切口(图1A)。用含1∶20万肾上腺素的1%利多卡因注射液行局部浸润麻醉，沿设计线切开头皮及皮下组织至肿物表面，于肿物表面钝性剥离，完整切除肿物，彻底止血，以生理盐水清洗创口。掀起V形皮瓣，自V形切口尖端逐针缝合头皮，至张力适中位置停止，将V形头皮瓣平铺覆盖创面，用美蓝标记重叠位置，切除多余的头皮组织(图1B)，将皮瓣插入剩余缺损内，并使头皮外形保持平整，缝合剩余切口，形成Y形状(图1C)。术区留置1~2条引流条，涂抹抗生素软膏。