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Sekundäre Wundheilung

Effektives Behandlungskonzept nach Basalzellkarzinomresektion im zentralen Mittelgesicht

Secondary wound healing

Effective treatment concept after basal cell carcinoma resection in the central midface

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Zusammenfassung

Die plastische Rekonstruktion von Vollhautdefekten nach tumorablativer Resektion im Gesichtsbereich ist ein allgemein anerkanntes Konzept. Im Gegensatz hierzu werden Sekundärheilungen bis heute kontrovers diskutiert. In der vorliegenden Arbeit werden 22 Patienten vorgestellt, deren Vollhautdefekte nach Basalzellkarzinomresektion im zentralen Mittelgesicht, bei nicht indiziertem Primärverschluss, einer sekundären Wundheilung überlassen wurden. Nach Tumorresektion und Blutstillung wurde die Wunde mit einer semipermeablen Membran abgedeckt. Auf eine antibiotische Prophylaxe und Analgesie konnte in allen Fällen verzichtet werden. Der erste Verbandswechsel wurde am 7. Tag vorgenommen, gefolgt von einer Wundrandreinigung und einem wöchentlichen Neuverband bis zur Epithelialisierung des Defekts. Unter Berücksichtigung verschiedener anatomischer Untereinheiten des Gesichts wurden für Defekte bis zu 2 cm Durchmesser nach Sekundärheilung funktionell und ästhetisch sehr gute Ergebnisse dokumentiert. Als besonders geeignet erscheinen konkave Defekte im Bereich des zentralen Mittelgesichts wie im medialen Augenwinkel, am lateralen Nasenabhang, in der Nasenflügelgrube und der Nasolabialfalte. Die sekundäre Wundheilung stellt in ausgewählten Regionen des Gesichts eine – im Vergleich zur chirurgischen Rekonstruktion – sichere, gesundheitsökonomisch sinnvolle und effektive Alternative dar.

Abstract

Plastic reconstruction of facial skin defects after tumor surgery is a commonly accepted principle. However, healing by secondary intention is discussed controversially. Here we describe a series of 22 patients after full thickness resection of basal cell carcinoma who underwent wound healing by secondary intention. A semipermeable membrane was used for wound dressing, which was changed on a weekly basis. No antibiotics or pain killers were necessary. Defects up to 2 cm, particularly those of concave subunits of the midface, entirely closed within 4–6 weeks, and secondary wound healing led to excellent functional and aesthetic results. Thus, secondary wound healing is a safe, effective and economic alternative to surgical reconstruction in selected facial areas.

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Authors and Affiliations

  1. HNO-Universitätsklinik, Universität Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    T.K. Hoffmann, J. Arnolds, P.J. Schuler, E. Kultas, J. Greve & S. Lang

  2. HNO-Klinik, TU München, München, Deutschland

    N. Mansour & M. Bas

  3. Kaiserberg-Klinik, Duisburg, Deutschland

    E. Kultas & A. Hilpert

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  1. T.K. Hoffmann
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  2. J. Arnolds
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  3. P.J. Schuler
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  4. E. Kultas
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  5. J. Greve
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  6. N. Mansour
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  7. M. Bas
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  8. S. Lang
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  9. A. Hilpert
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Correspondence to T.K. Hoffmann.

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Hoffmann, T., Arnolds, J., Schuler, P. et al. Sekundäre Wundheilung . HNO 60, 605–610 (2012). https://doi.org/10.1007/s00106-011-2473-y

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