Heppt W
Klinik für Hals-, Nasen-, Ohrenkrankheiten, Kopf-, Hals-, Plastische Gesichtschirurgie, Städtisches Klinikum Karlsruhe, Karlsruhe.
HNO. 2009 Apr;57(4):324-35. doi: 10.1007/s00106-009-1893-4.
As the incidence of facial skin tumors is rising, otorhinolaryngologists are becoming more and more involved in the field of facial plastic surgery. The most common tumor locations on the head are the sun-exposed areas such as the nose, forehead, cheek, and auricle. The most common histologic findings are actinic keratosis and basal cell carcinoma. In planning tumor resection and defect repair, many factors, including histology, size, and localization of the tumor as well as conditions of the adjacent skin, must be considered. The key to defect repair after tumor resection is to choose the most appropriate technique from a range of possibilities. Because of skin laxity, most small and midsize facial defects can be closed directly or with high-tension sutures under skin expansion. More extensive defects and those located in critical areas require pedicled flaps or free grafts transferring skin from adjacent or distant areas. In patients with recurrent or deeply infiltrative tumors, reconstructive procedures of the facial nerve, parotid duct, and lacrimal duct might be needed. This is also true for reconstruction of the anatomic framework of the eyelids, the nose, and the pinna.
随着面部皮肤肿瘤发病率的上升,耳鼻咽喉科医生越来越多地涉足面部整形手术领域。头部最常见的肿瘤部位是暴露于阳光下的区域,如鼻子、前额、脸颊和耳廓。最常见的组织学表现是光化性角化病和基底细胞癌。在规划肿瘤切除和缺损修复时,必须考虑许多因素,包括肿瘤的组织学、大小、位置以及相邻皮肤的状况。肿瘤切除后缺损修复的关键是从一系列可能性中选择最合适的技术。由于皮肤松弛,大多数中小型面部缺损可以直接闭合或在皮肤扩张下用高压缝线闭合。更广泛的缺损以及位于关键区域的缺损需要带蒂皮瓣或游离移植,从相邻或远处区域转移皮肤。对于复发或浸润较深的肿瘤患者,可能需要对面神经、腮腺导管和泪道进行重建手术。对于眼睑、鼻子和耳廓的解剖结构重建也是如此。