Lembo Fedele, Cecchino Liberato Roberto, Parisi Domenico, Portincasa Aurelio
Plastic and Reconstructive Surgery Department, Ospedali Riuniti-OORR, University of Foggia, Foggia 71100, Italy.
Dermatol Res Pract. 2020 Jul 20;2020:4874035. doi: 10.1155/2020/4874035. eCollection 2020.
Radical ablative surgery is the gold standard treatment of head skin cancer. The authors expose their experience with a new artificial dermis (Pelnac®), analyzing retrospectively the overall morbidity and aesthetic outcomes. 16 consecutive patients underwent two surgical procedures under local anesthesia. The first involved the tumor removal and application of the ADM. In the second, the exposed tissue was covered with a split-thickness skin graft. On follow-up (6 months), tumor recurrences, quality of scars (using the Vancouver Scar Scale), and patient reported outcomes (using FACE-Q Skin Cancer Module) were evaluated. 10 were males and 6 females, with a mean age of 73 years (61-89). The follow-up ranged from 12 to 48 months (mean: 30). The sites of skin tumor were scalp (12 cases), forehead (2), cheek (1), and zygomatic area (1). Nine patients underwent previous local surgery; two received radiotherapy. The average length of hospital stay was 3.2 days. The mean surface area of the defect was 59.15 cm (16.9-89.5). In three cases, the surgical bed was bone without periosteum. The malignant tumors excised were basal cell carcinoma (68.75%), squamous cell carcinoma (18.75%), malignant melanoma (6.25%), and sarcoma (6.25%). The mean operating time was 41 minutes for the first operation (25-55) and 34 for the second (25-48). No significant problems were observed and 15 patients (93.75%) had 100 percent intake of graft. The mean time of healing was 39 days (32-45). At 6 months post-op, no tumor recurrence. Satisfactory cosmetic and functional results were obtained in all patients as shown by the VSS Scale and FACEQ skin cancer module mean scores. We believe that the artificial dermis is a reliable alternative to flaps and should be considered an excellent option in head reconstruction for skin cancer, especially in critical patients (old, with large and deep defects, with recurrent tumors, required radiotherapy).
根治性切除手术是头部皮肤癌的金标准治疗方法。作者介绍了他们使用一种新型人工真皮（Pelnac®）的经验，回顾性分析了总体发病率和美学效果。16例连续患者在局部麻醉下接受了两次手术。第一次手术包括切除肿瘤并应用人工真皮基质。第二次手术是用中厚皮片覆盖暴露的组织。在随访（6个月）时，评估肿瘤复发情况、瘢痕质量（使用温哥华瘢痕量表）以及患者报告的结果（使用面部皮肤癌模块FACE-Q）。患者中男性10例，女性6例，平均年龄73岁（61 - 89岁）。随访时间为12至48个月（平均30个月）。皮肤肿瘤部位为头皮（12例）、前额（2例）、脸颊（1例）和颧部（1例）。9例患者曾接受过局部手术；2例接受过放疗。平均住院时间为3.2天。缺损的平均表面积为59.15平方厘米（16.9 - 89.5平方厘米）。3例患者的手术床为无骨膜的骨组织。切除的恶性肿瘤包括基底细胞癌（68.75%）、鳞状细胞癌（18.75%）、恶性黑色素瘤（6.25%）和肉瘤（6.25%）。第一次手术的平均操作时间为41分钟（25 - 55分钟），第二次为34分钟（25 - 48分钟）。未观察到明显问题，15例患者（93.75%）的移植皮片完全成活。平均愈合时间为39天（32 - 45天）。术后6个月时，无肿瘤复发。温哥华瘢痕量表和面部皮肤癌模块FACE-Q的平均评分显示，所有患者均获得了满意的美容和功能效果。我们认为，人工真皮是皮瓣的可靠替代物，应被视为头部皮肤癌重建的极佳选择，尤其是对于病情危急的患者（老年患者、有大而深的缺损、有复发性肿瘤、需要放疗的患者）。
