Elabjer Biljana Kuzmanović, Petrinović-Doresić Jelena, Busić Mladen, Elabjer Esmat, Kastelan Snjezana
University Department of Ophthalmology, Sveti Duh General Hospital, Zagreb, Croatia.
Coll Antropol. 2007 Jan;31 Suppl 1:91-6.
The paper presents our approach to reconstruction after periocular basalioma (pBCC) excision, especially of large lower lid (LL) and medial canthal (MC) pBCC. Retrospective analysis of data of 123 patients with pBCC, confirmed on histologic examination (HE), operated in period from 1998 to 2006, was performed. Oncologic safety margins of 3 mm were marked after local anesthesia was administered. Reconstruction was done in time of surgery. In pBCC away from a lid margin, adjacent myocutaneous flaps were used. For lid margin involving (LM) pBCC, size of 10 mm and less in horizontal diameter (HD), full-thickness lid excision was performed, combined with lateral canthotomy and/or Tenzel or McGregor flap. When size of LM pBCC was more than 10 mm in HD and it was on a LL, ipsilateral upper lid (UL) tarsoconjunctival (TC) graft combined with single pedicle transposition myocutaneous flap were used. The same size of LM pBCC on a UL required ipsilateral full-thickness LL "switch" flap and/or contralateral LL Hübner graft. In MC pBCC combined approach was used. The follow-up was up to 5 years. The 19 patients (15.4%) had positive tumor margin on HE. Five of them refused further surgery, but only two had recurrence. The rest of 121 patients had no recurrence during follow-up. In 5/14 patients, who underwent additional surgery, no tumor cells were found on HE. The 10/123 patients (8.1%) had complications. The imperative of our approach to reconstruction after pBCC was good functional and cosmetic result, avoiding prolonged lid closure. Accordingly, in large LL LM pBCC we used ipsilateral UL TC graft combined with single pedicle transposition myocutaneous flap. In MC pBCC combined approach was mandatory.
本文介绍了我们对眼周基底细胞癌（pBCC）切除术后重建的方法，尤其是针对大型下睑（LL）和内眦（MC）pBCC。对1998年至2006年期间接受手术、经组织学检查（HE）确诊的123例pBCC患者的数据进行了回顾性分析。局部麻醉后标记3mm的肿瘤安全切缘。手术时进行重建。对于远离睑缘的pBCC，采用邻近肌皮瓣。对于累及睑缘（LM）的pBCC，水平直径（HD）为10mm及以下的，行全层睑切除，联合外眦切开和/或Tenzel或McGregor瓣。当LM pBCC的HD大于10mm且位于LL时，采用同侧上睑（UL）睑板结膜（TC）移植联合单蒂移位肌皮瓣。UL上相同大小的LM pBCC需要同侧全层LL“转位”瓣和/或对侧LL Hübner移植。对于MC pBCC，采用联合方法。随访时间长达5年。19例患者（15.4%）HE检查显示肿瘤切缘阳性。其中5例拒绝进一步手术，但仅2例复发。其余121例患者在随访期间无复发。在14例接受额外手术的患者中，5例HE检查未发现肿瘤细胞。123例患者中有10例（8.1%）出现并发症。我们对pBCC重建方法的关键是获得良好的功能和美容效果，避免长时间睑闭合。因此，对于大型LL LM pBCC，我们采用同侧UL TC移植联合单蒂移位肌皮瓣。对于MC pBCC，联合方法是必要的。
