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Objective@#The clinical application of free perforator flaps in aesthetic repairing of the wounds of electric injuries in forearms and palms.@*Methods@#20 cases of skin tissue defects of electric injuries in forearms and palms were collected in this group, including 18 male patients and 2 female patients ranged from 20 to 50 years. The size of the skin defects are from 7 cm×5 cm to 18 cm×8 cm. 20 cases of forearms and palms with electric injuries, all of which were repaired by the transplantation of free musculocutaneous perforator monoflaps with anastomosis of interregional blood vessels. 10 cases of wounds in forearms were treated with lateral femoral circumflex artery perforator flaps with sensate nerves. The other 10 cases of wounds in palms were treated with medial plantar artery perforator flap with sensate nerves, with a flap area of 8 cm× 6cm to 20 cm×9 cm. In the donor area, 10 cases were closed with aesthetic suture and 10 cases were repaired with skin grafts.@*Results@#All flaps survived in 20 cases. Artery crisis was found in 1 case on the second day after surgery, and this flap with anastomosis of blood vessels also survived after surgical exploration without delay. The shapes and functions of palms and forearms were observed basically restored from a aesthetic point of view from a follow-up of 3 months to 36 months. Most touch, pain and warm senses were restored in cases with sensate nerves. And a two-point discrimination was 9—11 mm. A satisfactory functional recovery was achieved. The donor sites were found well-healed without any obvious scars or functional disorders.@*Conclusions@#Because of the advantages of hidden donor sites, reliable blood supply, closed texture and good abrasion-resistance, the multiple perforator sublobe flaps with sensate nerves could be adopted, and after thinning could be used as the free flaps to repair the wounds. These have predicted that this method is one of the desirable methods of aesthetic repairing and functional reconstruction of subunits skin tissue defects in palms and forearms.
ABSTRACT
Objective To investigate clinicopathological features,diagnosis and treatment of cutaneous Merkel cell carcinoma (MCC).Methods CNKI,Wanfang,Vip databases were searched for reported domestic cases of MCC from January 1,1986 to October 1,2017,and clinical data were collected,and retrospectively analyzed and summarized.Results During 31 years between 1986 and 2017,a total of 171 domestic cases of MCC were reported.There were 78 males and 93 females,and the ratio of male to female was 1:1.19.Of the 171 patients,136 (79.5％) were aged more than 50 years,and lesions mostly occurred on the head and face or extremities in 139 (81.3％) patients.Clinically,149 (87.1％) patients were misdiagnosed as tumor of unknown origin (89 cases,52％),malignant lymphoma (34 cases,19.9％),benign tumors (15 cases,8.8％) or non-tumor diseases (11 cases,6.4％).As for clinical stage,84 (49.1％) patients had stage Ⅰ MCC,and 49 (28.6％)had stage Ⅱ MCC.One patient received immunotherapy,and 165 patients underwent surgical resection,including 91 patients receiving surgery alone,24 patients treated with postoperative radiotherapy,19 patients treated with postoperative chemotherapy,and 31 patients receiving postoperative chemoradiotherapy.Five patients did not describe the treatment.Among 74 patients who were followed up after the surgery,one-year survival rate and five-year survival rate were 52.7％ and 6.8％ respectively.The five-year survival rate was 6.1％ in the patients with stage Ⅰ MCC,5.6％ in those with stage Ⅱ MCC,and 0 in those with stage Ⅲ and Ⅳ MCC.Conclusions In China,cutaneous MCC mostly occurs on the head,face,neck and extremities of the middle-aged or elderly,with a high misdiagnosis rate.Surgical excision combined with radiotherapy or chemotherapy is a frequently used treatment protocol in China,but the prognosis is always poor.