Verbruggen C, Ricard A S, Cogrel O, Bondaz M, Carrier S
Service de chirurgie maxillo-faciale, stomatologie et chirurgie orale, centre François-Xavier-Michelet, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
Service de chirurgie maxillo-faciale, stomatologie et chirurgie orale, centre François-Xavier-Michelet, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
Ann Chir Plast Esthet. 2018 Feb;63(1):47-53. doi: 10.1016/j.anplas.2017.06.005. Epub 2017 Jul 26.
The main objective of this study is to determine the necessary surgical margins to obtain a complete R0 resection for head and neck dermatofibrosarcoma protuberans (DFSP) using Slow-Mohs micrographic surgery. The secondary objective is to study the recurrence rate of these tumors.
Slow-Mohs micrographic surgery was used for patients included between 2005 and 2015 at Bordeaux universitary hospital. For each patient the age, the sex and death occurrence, the initial surgical margins, the surgical margins for complete R0 resection, the occurrence of local or general recurrence during follow-up were reported. Surgery was realized under local anesthesia. The closure of the tumor site was realized secondarily using a skin graft or local flap.
Twenty patients were included in the study. Initial surgical margins were 10mm (9 patients) or 15mm (11 patients). Complete resection was obtained from the first surgery for fifteen patients (75%). The average surgical margin for a complete R0 resection was 15,25±5,7mm (10-25). None of the patients presented recurrences during the entire follow-up (38 months) CONCLUSION: A complete R0 resection of head and neck DFSP is obtained from the first surgery in 75% of the cases, with minimum surgical margins (12,75±2,55mm) using the Slow-Mohs micrographic surgery. This allows a reduction of surgical margins and local recurrences. This technique provides a preservation of soft-tissues, which plays a key role for head and neck surgery.
本研究的主要目的是确定使用慢速莫氏显微外科手术对头颈部隆突性皮肤纤维肉瘤（DFSP）进行R0完全切除所需的手术切缘。次要目的是研究这些肿瘤的复发率。
对2005年至2015年间在波尔多大学医院就诊的患者采用慢速莫氏显微外科手术。记录每位患者的年龄、性别、死亡情况、初始手术切缘、R0完全切除的手术切缘、随访期间局部或全身复发的情况。手术在局部麻醉下进行。肿瘤部位的闭合随后采用皮肤移植或局部皮瓣完成。
20例患者纳入研究。初始手术切缘为10mm（9例患者）或15mm（11例患者）。15例患者（75%）首次手术即实现完全切除。R0完全切除的平均手术切缘为15.25±5.7mm（10 - 25mm）。所有患者在整个随访期（38个月）均未出现复发。结论：使用慢速莫氏显微外科手术，75%的头颈部DFSP患者首次手术即可实现R0完全切除，最小手术切缘为（12.75±2.55mm）。这使得手术切缘和局部复发率降低。该技术可保留软组织，这在头颈部手术中起着关键作用。
