Tamaş Camelia, Pintilie Cătălina Teodora, Atănăsoae Ionuţ Vivi, Corduneanu Andreea Mioara, Dabija Iulia, Olaru Florin Ştefan, Hreniuc Irina Mihaela, Tecuceanu Angela, Munteanu Ioana, Dobre Costel, Moraru Dan Cristian, Ianole Victor, Tamaş Ioana, Costan Victor Vlad
Department of Plastic Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania;
Rom J Morphol Embryol. 2018;59(1):285-291.
The face is an unfortunate location for any type of tumor - malignant or not - with significant esthetic and functional outcomes. To reconstruct a facial defect may seem simple, but can be rather complicated. The aim of this study is to analyze and discuss our results in order to conclude with specific surgical strategies correlated with the morphopathological results. The most important objective for us is to offer the highest level of expertise to our patients and to prove that the symbiosis between the surgical treatment and the work of the Department of Morphopathology is essential in order to maximize the quality of medical care provided for our patients.
PATIENTS, MATERIALS AND METHODS: A retrospective study was conducted on 116 patients diagnosed with facial malignant tumors, 70 of which were confirmed as basal cell carcinomas (BCCs), 35 confirmed as squamous cell carcinomas (SCCs) and 11 malignant melanomas (MMs). Most BCC cases (57) showed ulceration, with a long clinical evolution (more than 10 years) in 48 cases. Only in 12 SCC cases, patients showed inflammation and ulceration, with a shorter evolution period (2-5 years). For complete microscopic diagnosis, immunohistochemical (IHC) examination was necessary in 46 cases. The BCC "deceiving" clinical behavior and the generally aggressive character of the MM were found in our patients as well.
The most frequent sites were the orbital region (27 cases) and the nasolabial sulcus (26 cases). In order to reconstruct the postexcisional defects, we had to perform local flaps in 62 cases (14 frontal flaps for orbital defects, 32 glabellar flaps for medial epicanthus, lower lid and nasal region, 15 nasolabial flaps for lower lid or nasal alae and one "Z"-plasty for the submental region). Oncological follow-up was performed in all patients and in 15 cases re-excision was necessary (11 BCCs, two SCCs and two MMs). Cervical lymph node metastasis occurred in six cases (three BCCs, one SCC and two MMs).
The cooperation between surgeons and pathologists allowed for good outcomes and the pathology examination can guide the surgical approach towards better results both functionally and esthetically.
面部是各类肿瘤（无论恶性与否）的好发部位，会产生显著的美学和功能影响。面部缺损的重建看似简单，实则相当复杂。本研究旨在分析和讨论我们的结果，以便得出与形态病理学结果相关的具体手术策略。对我们而言，最重要的目标是为患者提供最高水平的专业治疗，并证明手术治疗与形态病理学部门的工作之间的共生关系对于最大化患者医疗护理质量至关重要。
患者、材料与方法：对116例诊断为面部恶性肿瘤的患者进行了回顾性研究，其中70例确诊为基底细胞癌（BCC），35例确诊为鳞状细胞癌（SCC），11例为恶性黑色素瘤（MM）。大多数BCC病例（57例）出现溃疡，48例临床病程较长（超过10年）。仅12例SCC病例中，患者出现炎症和溃疡，病程较短（2 - 5年）。为进行完整的显微镜诊断，46例患者需要进行免疫组织化学（IHC）检查。我们的患者中也发现了BCC“欺骗性”的临床行为以及MM通常具有的侵袭性特征。
最常见的部位是眶周区域（27例）和鼻唇沟（26例）。为修复切除后的缺损，我们在62例患者中进行了局部皮瓣手术（14例用于眶周缺损的额部皮瓣，32例用于内眦、下睑和鼻区的眉间皮瓣，15例用于下睑或鼻翼的鼻唇沟皮瓣，1例用于颏下区域的“Z”成形术）。对所有患者进行了肿瘤学随访，15例患者需要再次切除（11例BCC，2例SCC和2例MM）。6例发生颈部淋巴结转移（3例BCC，1例SCC和2例MM）。
外科医生和病理学家之间的合作带来了良好的结果，病理检查可以指导手术方法在功能和美学方面取得更好的效果。
