Horch Raymund E, Stark G Bjoern, Beier Justus P
Department of Plastic and Hand Surgery, University Hospital of Erlangen-Nuernberg, Friedrich-Alexander-University Erlangen-Nuernberg, Germany.
BMC Cancer. 2005 Nov 28;5:150. doi: 10.1186/1471-2407-5-150.
Squamous cell carcinomos may arise from chronic ulcerating wounds in scars, most commonly postburn scars. Tumour growth usually takes place over months to years. Localization on the scalp is a relatively rare condition.
This report presents the case of a 63-year-old man with chronic ulceration of a postburn scar of the scalp due to an electrical burn 58 years ago. Sudden tumour growth started within weeks and on presentation already had extended through the skull into frontal cortex. After radical tumour resection, defect was covered with a free radial forearm flap. Local recurrence occurred 6 weeks later. Subsequent wide excision including discard of the flap and preservation of the radial vessels was followed by transfer of a free latissimus dorsi muscle flap, using the radial vessels of the first flap as recipient vessels. The patient received radiotherapy post-operatively. There were no problems with flap survivals or wound healing. Due to rapidly growing recurrence the patient died 2 months later.
Explosive SCC tumour growth might occur in post-burn scars after more than 50 years. As a treatment option the use of sequential free flap connections might serve in repeated extensive tumour resections, especially in the scalp region, where suitable donor vessels are often located in distance to the defect.
鳞状细胞癌可能起源于瘢痕中的慢性溃疡性伤口，最常见于烧伤后瘢痕。肿瘤生长通常持续数月至数年。头皮部位的鳞状细胞癌相对少见。
本报告介绍了一名63岁男性患者，其头皮因58年前的电击伤形成烧伤后瘢痕，并伴有慢性溃疡。肿瘤在数周内突然生长，就诊时已穿透颅骨侵入额叶皮质。在进行根治性肿瘤切除后，缺损部位用游离桡侧前臂皮瓣覆盖。6周后出现局部复发。随后进行了广泛切除，包括切除皮瓣并保留桡动脉，接着转移了游离背阔肌皮瓣，将第一个皮瓣的桡动脉用作受区血管。患者术后接受了放疗。皮瓣存活及伤口愈合均无问题。但由于复发肿瘤生长迅速，患者在2个月后死亡。
烧伤后瘢痕在50多年后可能出现鳞状细胞癌的爆发性生长。作为一种治疗选择，序贯游离皮瓣连接可用于反复进行的广泛肿瘤切除，特别是在头皮区域，因为合适的供区血管通常与缺损部位有一定距离。
