顔面悪性腫瘍切除後再建における Unit principle の応用

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Malignant skin tumors are generally found on the face and should be treated with surgical excision routinely. The importance of surgical excision is beyond question and immediate reconstruction of facial full-thickness tissue defects is a commonly accepted surgical principle used to preserve function and minimize cosmetic deformity.In facial reconstruction, the excellent functional and esthetic results according to regional esthetic unit are familiar to most plastic surgeons. Recently, subunit principle has generally been employed and now further advanced miniunit principle has come to be advocated and applied.Tequniques and three case reports describe its application to facial full-thickness tissue defects after skin cancer surgery.Case 1: A 67-year-old man presented with a basal cell carcinoma measuring 32 × 21mm of the right cheek. There were no clinically positive lymphnodes. Excision of the tumor produced a defect of three-fourth of the right suborbital cheek zone. After arranging the defect fit the natural suborbital cheek subunit, recostruction was performed with an anteriorly based cervicofacial flap in exact size of missing subunit and secondary donor site defect was covered with an anteriorly based neck flap. Additional skin graft was performed to the retroauricular region hidden behind the ear.After operation the patient received chemotherapy with 90mg dose of pepleomycin. No evidence of recurrence has been noted for 2 years postoperatively and the patient now has almost normal symmetric appearance and function with concealed edge scars of the flap.Case 2: A 71-year-old man presented with a squamous cell carcinoma measuring 22 × 18mm of the right mandible. There were no clinically positive lymphnodes. Excision of the tumor produced a defect of three-fourth of the right buccomandibular cheek zone. After arranging the defect fit the natural buccomandibular cheek subunit, reconstruction was performed with a posteriorly based neck flap in exact size of missing subunit and secondary donor site defect was almost sutured primarily with an additional skin graft using formerly excized normal skin.After operation the patient received chemotherapy with 60mg dose of pepleomycin. No evidence of recurrence has been noted for 12 months postoperatively and the final result left the patient with adequate facial contour, normal appearing skin cover and concealed grafted skin.Case 3: A 49-year-old man presented with a dermatofibrosarcoma protuberans measuring 12mm in diameter of the right upper lip.Excision of the tumor produced a full thickness defect of three-fourth of the lateral subunit of the upper lip. The remaining tissues of the lateral subunit were excised. An exact pattern of the opposite normal lateral subunit is outlined and an Abbe flap was taken from the midline of the lower lip and transferred in two stages. No evidence of recurrence has been noted for 10 months postoperatively.Like tissue was replaced in kind, border scars are positioned esthetically, and the orbicularis sphincter is reconstituted with an intact symmetrical comissure, muscular modiolus, and upper and lower lip symmetry. In this series of patients, we have presented a method of facial reconstruction emphasizing the judicious choice and modificatin of recipient and donor tissue to provide for the exact replacement of facial full-thickness tissue defects as subunits, thereby reproducing the expected contours and landmarks that create the final excellent esthetic result.

顔面悪性腫瘍切除後再建における Unit principle の応用

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