随意微小皮瓣在颜面部皮肤缺损Ⅰ期修复中的应用

目的 观察随意微小皮瓣修复颜面部皮肤外科手术后皮肤缺损的效果.方法 203例颜面部皮肤外科手术患者,在切除皮损后,根据术中缺损情况设计随意微小皮瓣Ⅰ期修复皮肤缺损.结果 完成了8种205处皮瓣Ⅰ期修复颜面部皮肤缺损.其中182例术后效果佳,面部无牵拉变形,不是你、瘢痕隐蔽21例患者术后皮瓣远端表皮坏死.形成皮瓣的部位最常见于颊部.其次是眼睑、额部、颞部、耳前、颏部、应用最多的是滑行推进皮瓣,其次是旋转皮瓣.结论 合理设计个性化随意微小皮瓣Ⅰ期修复颜面部小面积皮肤缺损.可获满意疗效和美容效果.     

延迟性皮肤重复扩张术在皮肤外科的应用

目的探讨一种修复头皮部大面积皮肤软组织缺损的有效方法。方法采取皮肤扩张术治疗头部大面积色素痣、瘢痕、皮脂腺痣、疣状血管瘤等皮肤良性损害,对1次皮肤扩张术治疗不完全的15例患者,待前期切口愈合6～11个月后,采取重复扩张术再次扩张治疗,直至皮损被完全切除。结果15例患者经重复扩张术再次治疗后.14例患者皮损被全部切除,1例剩余2%的皮损,均取得满意的效果,未发生并发症。结论延迟性重复皮肤扩张术是目前治疗大面积皮肤良性损害切除后大面积皮肤软组织缺损的理想方法。     

皮肤恶性肿瘤的Mohs显微外科切除与缺损的修复

皮肤恶性肿瘤以基底细胞癌、鳞状细胞癌为多见，我科于2004年8～12月采用Mohs显微外科切除、即期行缺损整形修复手术8例，取得了满意的疗效，现报告如下。     

基底细胞癌的治疗

基底细胞癌是最常见的皮肤恶性肿瘤,该病几乎不发生转移,如不治疗,肿瘤会发生局部浸润性生长而破坏邻近组织,影响功能和美观,严重时危及生命.基底细胞癌的治疗方法很多,主要分为手术疗法和非手术疗法.手术疗法是首选的治疗手段,包括常规手术切除和Mohs显微外科手术切除,较大的缺损可以通过多种治疗手段进行创面修复.非手术疗法包括光动力学疗法、放射治疗、局部化疗、免疫调节剂治疗以及分子靶向治疗等.     

【开放获取】局部皮瓣联合修复鼻及鼻周Mohs显微外科手术后较大缺损11例效果分析

【摘要】 目的 探讨局部皮瓣联合应用修复鼻及鼻周非黑素瘤皮肤癌Mohs显微外科手术后较大缺损的效果及优势。方法 2018年3月至2020年11月,于河北医科大学第二医院皮肤科收集行Mohs显微外科切除术后应用局部皮瓣联合修复的11例鼻及鼻周非黑素瘤皮肤癌患者。 根据术后缺损部位及大小,遵循鼻亚单位美学原则设计皮瓣进行修复,对于直接缝合或单个局部皮瓣无法覆盖的较大缺损,联合应用风筝皮瓣、改良菱形皮瓣、鼻唇沟皮瓣、双叶皮瓣等局部皮瓣中2 ~ 3种皮瓣修复创面。结果 11例患者中,基底细胞癌10例,鳞状细胞癌1例,缺损面积2.0 cm × 2.3 cm～2.7 cm × 3.6 cm。经Mohs显微外科手术联合局部皮瓣修复后皮瓣均存活良好,未出现血运障碍,修复皮瓣质地、颜色、轮廓等与周围正常皮肤相近,缺损未见明显瘢痕。术后随访4 ~ 32个月,肿瘤无复发,患者对外观满意。结论 联合应用2 ~ 3种皮瓣修复鼻及鼻周非黑素瘤皮肤癌Mohs手术后的较大缺损,可保持鼻及鼻周正常形态结构和美学效果,达到满意的美容修复效果。     

显微镜控制下切除皮肤肿瘤

显微镜控制下切除皮肤肿瘤最早是由Mohs提倡的.每个治疗皮肤肿瘤的医生都面临难治的肿瘤,肿瘤复发及组织损伤等问题.过高估计肿瘤恶性程度及范围常导致切除过多正常组织,造成不必要的组织缺损,而估计不足常会因切除不彻底而致肿瘤复发.Mohs创建的在显微镜检查下切除皮肤肿瘤能切除临床上肉眼不能识别的"肿瘤亚临床扩散",这样手术治疗更为准确和彻底.同时又尽可能多地保留了肿瘤周围的正     

应用三叶皮瓣修复基底细胞癌术后鼻尖鼻翼巨大缺损

鼻位于面部中央,立体感强,对面部美学有重要的影响,同时也是皮肤肿瘤的好发部位。在手术切除肿瘤的同时需要使用合适的方法修复手术缺损区域,达到不影响鼻外观和功能的效果。由于鼻部结构较复杂,皮肤及皮下组织连接紧密,皮肤移动度较小,因此鼻部肿瘤切除后缺损修复比较困难,尤其是鼻尖鼻翼的巨大缺损既往没有较好的修复方式。     

Burow推进皮瓣修复面部皮肤肿瘤切除术后创面缺损

面部肿瘤切除手术后常遗留大小不等的皮肤缺损,缺损面积较小者除可直接拉拢缝合外,大部分创面需要局部转移皮瓣或游离皮片移植来修复。2007年7月至2011年7月,我科收治32例面部肿瘤患者,采用手术切除皮损,术后缺损应用Burow楔形推进皮瓣进行一期修复,取得满意效果……     

邻位皮瓣修复术修复面部肿瘤切除后皮肤缺损

目的总结面部肿瘤切除后邻位皮瓣修复术修复皮肤缺损的经验。方法在全身麻醉或局部麻醉下,行皮肤病变切除,根据切除肿瘤皮肤缺损大小、部位、深度,采取A-T皮瓣、旋转皮瓣、斧形皮瓣等修复创面。结果共46处皮肤缺损,通过皮瓣转移均达到理想修复效果,未出现皮瓣坏死及并发症。结论邻位皮瓣修复面部肿瘤切除后皮肤缺损,术后无组织和器官变形,瘢痕隐蔽,与周围皮肤颜色无差别。     

手术治疗头面部基底细胞癌76例

基底细胞癌治疗的首选方法是外科手术切除.在治疗过程中,为了保证肿瘤组织被彻底切除干净,皮肤外科医生会根据临床经验采用局部扩大切除术.由于基底细胞癌多发生于头面部,过多的切除皮肤组织会使皮肤缺损的修复变得很困难,因而严重影响患者的容貌.     

改良Mohs显微描记手术治疗Merkel细胞癌二例

【摘要】 Mohs显微描记手术是切除皮肤肿瘤的理想术式。本文2例Merkel细胞癌患者行改良Mohs显微描记手术切除肿瘤，随访1年余，肿瘤未复发。与传统扩大切除术相比，改良Mohs手术是Merkel 细胞癌患者更好的选择。     

改良Mohs显微描记手术治疗小汗腺汗孔癌5例

目的探讨改良Mohs显微描记手术治疗小汗腺汗孔癌的效果。方法回顾2016—2020年武汉市第一医院皮肤科治疗的5例小汗腺汗孔癌患者临床资料, 采用改良Mohs显微描记手术治疗。结果 5例年龄52 ～ 80岁, 男2例, 女3例, 病史1 ～ 50年。皮疹分别位于头皮、面部、腹部、大腿、足部, 直径1 ～ 6 cm。沿皮疹周围1 cm切除, 深度至筋膜浅层, 切缘组织病理阴性行皮瓣或植皮闭合缺损面, 阳性则继续扩切, 切净为止。5例患者随访1 ～ 5年未见复发, 1例因肝癌转移术后2年死亡。结论改良Mohs显微描记手术治疗小汗腺汗孔癌可确保肿瘤切净, 并减少正常组织的损失。     

Mohs micrographic surgery in rare cutaneous tumors: a retrospective study at a Brazilian tertiary university hospital

BackgroundMohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique.ObjectiveTo study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors.MethodsThis was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021.ResultsDuring the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up.Study limitationsThis is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn’t widely available in the public service.ConclusionThis retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.     

Mohs micrographic surgery for cutaneous malignancies: A focus review of its indications in pediatric age groups

Mohs micrographic surgery (MMS) is a highly specialized technique that has been successful in the treatment of a variety of skin tumors. The technique can be performed as an outpatient procedure and encompasses surgical excision and intraoperative assessment of tumor margins in one setting by the same physician. The process ensures precise margin control with maximal preservation of healthy tissues. Mohs micrographic surgery has been practiced worldwide, including in the United States, Europe (United Kingdom, Germany, Spain, Netherlands, Switzerland), and Australia. Although it is commonly performed in adults with greater success, it has been discussed less frequently in children. In this article, we describe several cutaneous tumors in children and the role of Mohs micrographic surgery in their management. A PubMed search was conducted to review the most common cutaneous tumors in children treated using Mohs micrographic surgery. In this review, we discuss indications for Mohs micrographic surgery and pertinent studies examining success rates in children. Mohs micrographic surgery has been used to treat several tumors in children and offers the advantage of high cure rates and tissue conservation. This report emphasizes the benefits of Mohs micrographic surgery in children and highlights several cutaneous tumors for which it has been used to treat successfully.     

Histological evaluation of residual basal cell carcinoma after shave biopsy prior to Mohs micrographic surgery

Background Patients who are referred for Mohs surgery after pre‐operative biopsy has been performed show in some cases no clinical or pathological evidence of tumour persistence. We have previously shown that 25% of these patients show no residual skin cancer either basal cell carcinoma or squamous cell carcinoma. The reasons for ‘disappearance’ of the tumour may be true non‐persistence or false non‐persistence because of wrong‐site Mohs surgery. Objective To determine the incidence of residual basal cell carcinoma after shave biopsy of primary nodular basal cell carcinoma prior to Mohs micrographic surgery. Methods A prospective unblinded study was performed on patients undergoing Mohs surgery for primary nodular basal cell carcinoma. The tumour was removed as a shaved excision using a No. 15 blade at the clinical borders like a shave biopsy (Mohs shave). The bases of the tumors were excised and then sectioned vertically at the middle and cut to the periphery at 10–15 μm intervals till the edge. Results Fifty‐one patients were evaluated. In 40 patients, residual basal cell carcinoma was found at the base of the shave excision site (78.4%). Conclusions Pre‐operative shave biopsy performed during Mohs surgery for primary nodular basal cell carcinoma is ‘curative’ in 22% of the patients.     

Keep it simple. A ten-year experience in reconstructions after Mohs micrographic surgery

BackgroundMohs micrographic surgery is worldwide used for treating skin cancers. After obtaining tumor-free margins, choosing the most appropriate type of closure can be challenging.ObjectivesOur aim was to associate type of surgical reconstructions after Mohs micrographic surgery with the characteristics of the tumors as histological subtype, anatomical localization and especially number of surgical stages to achieve complete excision of the tumour.MethodsTransversal, retrospective analyses of medical records. Compilation of data such as gender, age, tumor location, histological subtype, number of stages to achieve clear margins and type of repair used.ResultsA total of 975 of facial and extra-facial cases were analyzed. Linear closure was the most common repair by far (39%) and was associated with the smallest number of Mohs micrographic surgery stages. This type of closure was also more common in most histological subtypes and anatomical locations studied. Using Poisson regression model, nose defects presented 39% higher frequency of other closure types than the frequency of primary repairs, when compared to defects in other anatomic sites (p < 0.05). Tumors with two or more stages had a 28.6% higher frequency of other closure types than those operated in a single stage (p < 0.05).Study limitationsRetrospective study with limitations in obtaining information from medical records. The choice of closure type can be a personal choice.ConclusionsPrimary closure should not be forgotten especially in surgical defects with fewer stages and in non-aggressive histological subtypes in main anatomic sites where Mohs micrographic surgery is performed.     

Rapid HMB-45 staining in Mohs micrographic surgery for melanoma in situ and invasive melanoma

BACKGROUND: Accurate interpretation of frozen sections in the treatment of melanoma by Mohs micrographic surgery may be difficult. OBJECTIVE: Our purpose was to review the literature on the role of Mohs micrographic surgery in the treatment of melanoma and to demonstrate the added benefits of using rapid HMB-45 staining in Mohs micrographic surgery for the treatment of melanoma. METHODS: Twenty cases of melanoma were included in our study. Histologic diagnosis in each case was made by means of excisional biopsy specimens and permanent sections. Mohs micrographic surgery was performed with 3-mm margins used for each stage. Each Mohs frozen section was stained with HMB-45. In addition, routine frozen sections stained with hematoxylin-eosin were also prepared for comparison. All tissues were also sent for permanent sections. These permanent sections were cut similarly to Mohs-oriented sections because they were sectioned horizontally. Since they were serving as the standard, no staining with HMB-45 was performed on these permanent sections. Further stages with 3-mm margins were taken until tissues stained negative. Frozen sections were compared with permanent sections at each stage of resection. RESULTS: Eleven of the 20 cases stained positive with HMB-45 antibody on the first Mohs stage. These results were consistent with findings on permanent sections. Ten of the 11 cases were cleared by the first stage. One of the 11 cases required 3 stages because margins were not cleared and the specimens stained HMB-45 positive. However, permanent sections in this case revealed no tumor in the second stage. Nine of 20 cases did not stain with HMB-45 on the first layer of Mohs excision. This was consistent with findings on permanent sections. CONCLUSION: HMB-45 staining serves as a rapid technique to aid in the interpretation of frozen sections during Mohs micrographic surgery in the treatment of melanoma.     

Mohs显微描记手术治疗皮肤恶性肿瘤56例临床分析

目的探讨Mohs显微外科手术治疗皮肤恶性肿瘤的临床效果。方法对56例皮肤恶性肿瘤沿皮损周围行扩大切除术,将切除的边缘组织染色,按Mohs显微描记手术法冰冻切片,观察残余肿瘤细胞情况。结果 56例患者随访1～5年,其中53例患者伤口愈合良好,美容效果佳,无复发现象,56例中仅复发3例。结论 Mohs显微外科手术治疗皮肤恶性肿瘤具有损伤小、美容效果好、复发率低和安全性好的优点。     

Mohs micrographic surgery: a review of indications,technique, outcomes,and considerations

Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies. Certain skin cancers can have small extensions or “roots” that may be missed if an excised tumor is serially cross-sectioned in a “bread-loaf” fashion, commonly performed on excision specimens. The method of Mohs micrographic surgery is unique in that the dermatologist (Mohs surgeon) acts as both surgeon and pathologist, from the preoperative considerations until the reconstruction. Since Dr. Mohs’s initial work in the 1930s, the practice of Mohs micrographic surgery has become increasingly widespread among the dermatologic surgery community worldwide and is considered the treatment of choice for many common and uncommon cutaneous neoplasms. Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications, most of them managed by Mohs surgeons in their offices. Mohs micrographic surgery is the standard of care for high risks basal cell carcinomas and cutaneous squamous cell carcinoma and is commonly and increasingly used for melanoma and other rare tumors with superior cure rates. This review better familiarizes the dermatologists with the technique, explains the difference between Mohs micrographic surgery and wide local excision, and discusses its main indications.