Smyth A G
Department of Plastic Surgery, Shotley Bridge General Hospital, Consett, Co. Durham.
Br J Oral Maxillofac Surg. 1992 Jun;30(3):157-60. doi: 10.1016/0266-4356(92)90147-b.
A prospective study of 134 patients undergoing excision of a facial lesion was undertaken. Considerable clinical diagnostic difficulty was experienced, with 21% of clinical diagnoses being incorrect. A tendency towards a clinical over-diagnosis of basal cell carcinoma was noted and whilst this is not unreasonable, a number of benign lesions inevitably were diagnosed as malignant with unnecessary sacrifice of tissue. Incisional biopsy of lesions should be considered when sited close to important anatomical structures to enable accurate diagnosis prior to definitive surgery. Although a few definite indications for a particular reconstructive technique exist (Table 1), a choice is more often available. Repair of the excisional defect with a local flap as opposed to a skin graft resulted in a reduced length of hospital admission with fewer postoperative complications and better final cosmesis. As a consequence, a local flap is recommended as the method of repair where direct closure is not feasible.
对134例接受面部病变切除的患者进行了一项前瞻性研究。临床诊断存在相当大的困难，21%的临床诊断不正确。注意到有对基底细胞癌进行临床过度诊断的倾向，虽然这并非不合理，但一些良性病变不可避免地被诊断为恶性，导致不必要的组织牺牲。当病变位于重要解剖结构附近时，应考虑进行切开活检，以便在确定性手术前进行准确诊断。虽然存在一些特定重建技术的确切指征（表1），但更多时候有多种选择。与植皮相比，用局部皮瓣修复切除缺损可缩短住院时间，减少术后并发症，并获得更好的最终美容效果。因此，在直接缝合不可行时，建议采用局部皮瓣作为修复方法。
