| Objectives:To summarize and analyze the clinical characteristics of patients with scalp malignant tumor and the best repair method after resection,and to explore the influence of different repair methods on the postoperative quality of life of patients.Methods:The clinical and pathological data of 98 patients with scalp malignancies admitted to our hospital from October 2013 to June 2018 were statistically analyzed.Respectively to the patient's age,gender,lesion location,size and depth,timing of onset,performance,defect condition of head wound after lesion resection and repair method,donor and recipient complications,and pathological examination results,the differences between the clinical diagnosis and pathological diagnosis,patients' quality of life survey results for statistical analysis.The quality of life survey was conducted through telephone interviews and outpatient visits.The questionnaire was conducted using the MOST item short form health survey(SF-36).Statistical data were analyzed and calculated using SPSS 18.0 software,and were described by(mean standard ±deviation),median or percentage according to data properties.T-test or chi-square test was used for data comparison.The area under the ROC curve was selected to describe the difference between clinical diagnosis and pathological diagnosis.The test standard(=0.05),P<0.05 was considered statistically significant.Results:In the past 5 years,a total of 98 cases of scalp malignant tumors were admitted to our department(confirmed by postoperative pathological examination as malignant tumors).The youngest was 18 years old,the oldest was 86 years old,the average age was(59.26±16.89)years old,and the age was?55 years old with 61 people(62.24%).There were 55 males(56.12%)and 43 females(43.88%).There were 65 patients(66.33%)with lesions located in the head and forehead,and 29 patients(29.59%)with lesions located in the temporal region.The preoperative lesion area was 0.48cm2-204.00cm2,with a median(13.25cm2).There were 33 patients(34.02%)with periosteal lesions,and 16 patients(16.50%)with skull and intracranial lesions.The onset time of the patients ranged from 1 month to 50 years,with 31 patients(32.63%)coming on within 1 year,38 patients(38.78%)coming on within 1 year to 10 years,and 29 patients(29.59%)developed the disease over 10 years.There were 38 patients(38.78%)with mass appearance,24 patients(24.49%)with ulcer appearance,13 patients(13.27%)with scar ulcer appearance,10 patients(10.20%)with trauma or postoperative wound appearance,and 13 patients(13.27%)with papule appearance,pigmented nevus,warty nevus and pigmentation appearance.After conventional resection,the defect area of the scalp was 1.00cm2-300.00cm2,with a median(21.00cm2).The defect was repaired by direct suture in 9 cases,skin grafting in 17 cases,local skin flap in 24 cases,local skin flap combined with skin grafting in 30 cases,and free skin flap grafting in 16 cases.There were 54 patients(87.10%)with good healing and 3 patients(4.84%)with poor healing.Among the 98 patients,68(69.39%)had squamous cell carcinoma(SCC),7(7.14%)had basal cell carcinoma(BCC),17(17.35%)had squamous cell carcinoma mixed basal cell carcinoma(SCC+BCC),4(4.08%)had fibrosarcoma,1(1.02%)had sebaceous adenocarcinoma,and 1(1.02%)had angiosarcoma.The area under the pathological diagnosis curve was 1.00,and the area under the clinical diagnosis curve was 0.93.Of the 98 patients,3 died,2 were lost and 1 was no surgery.The remaining 92 patients underwent postoperative quality of life survey.The total score of patients with direct suture repair was(895.11±5.93),the total score of skin graft(852.02±49.55),and the total score of local flaps(883.04±15.23).The total score of local flap combined with skin grafting(818±65.73),total free flap(717.05±39.90),paired T test between groups,and the P values were all<0.05,and the results were statistically significant.Preoperative quality of life was investigated in 15 patients who used free flaps and survived.Preoperative and postoperative physical functioning(69.33±9.04,88.33±6.17),role-physical(26.67±17.59,73.33±14.84),bodily pain(59.93±19.37,94.40±8.92),general health(22.00±11.15,57.93±15.07),vitality(43.33±22.57,77.33± 6.78),social functioning(44.33±13.97,78.67±7.43),role-emotional,(28.89±21.33,84.45±17.21),mental health(55.47±17.94,79.27±8.08)and healthy transition(18.33±22.09,83.33± 12.20),all performed paired T test,P value<0.05,and the results were statistically significant.Conclusion:1 Malignant tumors of the scalp often occur in men over 55 years old,and most of the lesions are located on the top of the head and forehead.Most patients can receive appropriate treatment when the lesion is small and the invasion depth is shallow.Patients who had the disease within 1 year and above 10 years had the most cases.The main appearances were tumors,ulcers,scar ulcers,surgical or traumatic wounds.Squamous cell carcinoma is more common in pathological diagnosis.2 Surgery is still the main treatment method for malignant scalp tumors at present,and the appropriate repair method should be selected according to the patient's age,gender,specific conditions of the lesion and the degree of postoperative tissue defect.3 The quality of life survey results suggest that the smaller the lesion area,the shallower the depth of invasion,the simpler the surgical treatment required,and the better the quality of life after surgery.4 For patients with complex lesions,involving the skull and intracranial tissue,surgical treatment can also significantly improve the quality of life of patients. |
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