Torresetti Matteo, Gioacchini Matteo, Scalise Alessandro, Di Benedetto Giovanni
Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Via Conca 71, 60126, Ancona, Italy.
Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Via Conca 71, 60126, Ancona, Italy.
Int J Surg Case Rep. 2019;63:23-26. doi: 10.1016/j.ijscr.2019.08.034. Epub 2019 Sep 11.
Giant basal cell carcinomas are rare and potentially aggressive skin malignancies that are infrequently reported in the Literature, and they usually require aggressive surgical resection and immediate soft tissue reconstruction with skin grafts or flaps. The large size of GBCCs has relevant implications not only for the metastatic potential, but even for the reconstructive challenging due to the possible limited availability of tissues for flap coverage.
We report the peculiar case of an old patient who underwent to GBCC resection of the back measuring 16 × 13 cm, and immediate reconstruction with a large O to Z flap harvested from the back; one-year follow-up examination revealed a satisfactory result and no recurrence of the disease was observed.
The review of the Literature showed that reconstructive options are mainly determined by the site and extent of the defect, exposed structures and patient characteristics and comorbidities, and previous series reported the use of skin grafts only, pedicled myocutaneous or perforator flaps, exclusively free flaps and a combination of techniques. Therefore, in this scenario local flaps such as O-Z flaps are less invasive procedures, that usually have lower rate of postoperative complications and shorter hospitalization compared to more complex procedures.
Despite the use of O-Z flap is quite unusual for back reconstruction, we believe that this flap represents a valid and safe alternative in selected cases, particularly in the elderly and medically compromised patients with multiple comorbidities.
巨大基底细胞癌是一种罕见且具有潜在侵袭性的皮肤恶性肿瘤，文献中报道较少，通常需要积极的手术切除，并立即用皮肤移植或皮瓣进行软组织重建。巨大基底细胞癌的大尺寸不仅对转移潜能有相关影响，甚至由于皮瓣覆盖的组织可用性可能有限，对重建也具有挑战性。
我们报告了一例特殊病例，一名老年患者接受了背部16×13厘米的巨大基底细胞癌切除术，并立即用从背部获取的大O-Z皮瓣进行重建；一年的随访检查显示结果满意，未观察到疾病复发。
文献回顾表明，重建方案主要由缺损的部位和范围、暴露的结构、患者特征和合并症决定，先前的系列报道仅使用了皮肤移植、带蒂肌皮瓣或穿支皮瓣、单纯游离皮瓣以及技术组合。因此，在这种情况下，诸如O-Z皮瓣等局部皮瓣是侵入性较小的手术，与更复杂的手术相比，通常术后并发症发生率较低且住院时间较短。
尽管使用O-Z皮瓣进行背部重建相当罕见，但我们认为在某些特定病例中，特别是在患有多种合并症的老年和身体状况不佳的患者中，这种皮瓣是一种有效且安全的选择。
