Hodgkinson D J, Lam Q
Skin and Cancer Foundation, Sydney, New South Wales, Australia.
Australas J Dermatol. 2001 Feb;42(1):9-14. doi: 10.1046/j.1440-0960.2001.00465.x.
Mohs' surgery in the face has established itself as the optimal technique for a high cure rate of basal cell and squamous cell carcinoma occurring in the skin of the face. However, after the resection in Mohs' surgery, the defects, when extensive, require careful, planned reconstruction in order to produce a good cosmetic result. Although flap reconstruction is available for smaller lesions, larger defects can be covered often by expansion techniques. The expansion technique involves placing a silastic expander of various size and designs underneath the adjacent skin and, over a period of weeks, injecting saline into the expander in order to increase the amount of skin available for future flap reconstruction. This usually represents a two-stage procedure consisting of the insertion of the expander and, some weeks later, removal of the filled expander when there is sufficient tissue, and using this tissue to reconstruct the initial Mohs' defect by a flap. When defects are greater than half the aesthetic unit of the face, or greater than one-third in the forehead, or over 6 cm in the scalp, expansion techniques should be considered for reconstruction.
莫氏手术已成为治疗面部皮肤基底细胞癌和鳞状细胞癌、实现高治愈率的最佳技术。然而，在莫氏手术切除后，若缺损范围较大，则需要精心规划重建，以获得良好的美容效果。虽然较小的缺损可用皮瓣重建，但较大的缺损通常可采用扩张技术修复。扩张技术是将不同尺寸和设计的硅橡胶扩张器置于相邻皮肤下方，在数周时间内，向扩张器内注入生理盐水，以增加可供未来皮瓣重建的皮肤量。这通常是一个两阶段的过程，包括植入扩张器，几周后，当有足够的组织时取出已充盈的扩张器，并利用该组织通过皮瓣修复最初的莫氏手术缺损。当缺损大于面部美学单位的一半、大于前额的三分之一或头皮超过6厘米时，应考虑采用扩张技术进行重建。
