Lee Su-Hyun, You Hi-Jin, Lee Yun-Hwan, Kim Deok-Woo
Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea.
Arch Plast Surg. 2020 Jan;47(1):88-91. doi: 10.5999/aps.2019.00927. Epub 2020 Jan 15.
Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignancy. This report describes the case of an unusual extensive SCC involving the whole hemiface, which required reconstruction with a combination of a dual vascular free transverse rectus abdominis muscle (TRAM) flap and a skin graft. A 79-year-old woman visited our hospital with multiple large ulcerated erythematous patches on her right hemiface, including the parieto-temporal scalp, bulbar and palpebral conjunctiva, cheek, and lip. A preliminary multifocal biopsy was performed in order to determine the resection margin, and the lesion was resected en bloc. Orbital exenteration was also performed. A free TRAM flap was harvested with preserved bilateral pedicles and was anastomosed with a single superior thyroidal vessel. The entire TRAM flap survived. The final pathological examination of the resected specimen confirmed that there was no regional nodal metastasis, perineural invasion, or lymphovascular involvement. The patient was observed for 6 months, and there was no evidence of local recurrence. Usage of a TRAM flap is appropriate for hemifacial reconstruction because the skin of the abdomen matches the color and pliability of the face. Furthermore, we found that the independent attachment of two extra-flap anastomoses to a single recipient vessel can safely result in survival of the flap.
皮肤鳞状细胞癌（SCC）是第二常见的皮肤恶性肿瘤。本报告描述了一例罕见的广泛性SCC累及整个半侧面部的病例，该病例需要采用双血管游离腹直肌肌皮瓣（TRAM瓣）和皮肤移植联合进行重建。一名79岁女性因右半侧面部出现多个大的溃疡性红斑斑块前来我院就诊，这些斑块包括顶颞部头皮、球结膜和睑结膜、脸颊及唇部。为确定切除边缘进行了初步多部位活检，然后将病变整块切除。还进行了眶内容摘除术。采用保留双侧蒂的方式切取游离TRAM瓣，并与单一甲状腺上血管进行吻合。整个TRAM瓣存活。切除标本的最终病理检查证实无区域淋巴结转移、神经周围侵犯或淋巴管受累。对患者进行了6个月的观察，无局部复发迹象。使用TRAM瓣进行半侧面部重建是合适的，因为腹部皮肤与面部的颜色和柔韧性相匹配。此外，我们发现将两个瓣外吻合独立连接到单一受区血管可安全地使瓣存活。
