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Erfahrungen in der chirurgischen Versorgung von Gesichtshautbasaliomen und plastischen Rekonstruktionsverfahren

Experiences with surgical management of facial basal cell carcinoma and procedures for plastic reconstruction

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Zusammenfassung

Fragestellung

Rezidivfreiheit und das ästhetische Erscheinungsbild sind nach erfolgter R0-Resektion und plastischer Rekonstruktion des Gesichtes die Hauptanliegen in der chirurgischen Behandlung von Basaliomen. In dieser Studie sollten daher neben der Rezidivrate auch insbesondere die verschiedenen rekonstruktiven Techniken bewertet werden.

Patienten und Methoden

205 Patienten aus der Tumorsprechstunde, welche sich von 1998 bis 2002 einer Basaliomresektion und Gesichtshautrekonstruktion unterzogen hatten, wurden in die Studie aufgenommen und die Daten retrospektiv analysiert.

Ergebnisse

Am häufigsten waren Basaliome in der nasalen (40,5%) und orbitalen (22,9%) Region lokalisiert. Die Rezidivrate betrug 7,3% nach im Mittel 2,5 Jahren (6 Monate bis 5 Jahre). Nahlappenplastiken, Vollhauttransplantate und Dehnungsplastiken wurden am häufigsten durchgeführt, Indikationen für Spalthauttransplantate waren selten. Sensibilitätsstörungen lagen bei nur 3,6% der Dehnungsplastiken und 11,7% der Nahlappenplastiken, jedoch bei 22,7% der Vollhaut- und 38,7% der Spalthauttransplantate vor. Das ästhetische Ergebnis, evaluiert aus der klinischen Inspektion und einer Patientenskala, wurde bei 88,4% der Nahlappenplastiken, 92,6% der Dehnungsplastiken, aber bei nur 66,4% der Vollhaut- und 54% der Spalthauttransplantate als „unauffällig“ und „gut oder sehr gut“ eingestuft.

Schlussfolgerung

Nahlappen- und Dehnungsplastiken ergeben ein besseres ästhetisches und neurologisches Ergebnis nach Gesichtshautrekonstruktionen. Hauttransplantate sind Alternativverfahren bei kritischen Indikationen für Lappenplastiken.

Abstract

Background

No recurrences and optimal aesthetic outcomes after R0 resection and plastic reconstruction of the face are the goals in the surgical treatment of basal cell carcinoma. The aim of this study was to evaluate recurrence rates and to evaluate different reconstructive techniques.

Patients and methods

This study included 205 follow-up patients undergoing R0 resection of primary basal cell carcinoma and facial skin reconstruction between 1998 and 2002; data were analyzed retrospectively.

Results

The most frequent locations of basal cell carcinoma were the nasal (40.5%) and orbital (22.9%) regions. The rate of recurrence after 2.5 years (6 months–5 years) was 7.3%. Local flaps, full-thickness skin grafts, and sliding flaps were usually performed; indications for split-thickness skin grafts were rare. Disturbances of sensation were found in only 3.6% of the sliding flaps and in 11.7% of the local flaps, but 22.7% in full-thickness and 38.7% in split-thickness skin grafts. The aesthetic outcome, evaluated by clinical inspection and a patient satisfaction score, was classified as “unobtrusive” and “good or excellent” for 88.4% of local flaps, 92.6% of sliding flaps, but only for 66.4% of full-thickness and 54% of split-thickness skin grafts.

Conclusion

Local flaps and sliding flaps result in better aesthetic and neurological outcomes after reconstruction of facial skin regions. Skin grafts have their indications as an alternative procedure in cases of critical indications for flaps.

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Authors and Affiliations

  1. Klinik für Mund-, Kiefer- und Gesichtschirurgie, plastische Operationen und spezielle Schmerztherapie, Klinikum Bremen-Mitte

    J. Rustemeyer, V. Thieme, L. Günther & A. Bremerich

  2. Klinik für Mund-, Kiefer- und Gesichtschirurgie, plastische Operationen und spezielle Schmerztherapie, Klinikum Bremen-Mitte, St.-Jürgen-Straße 1, 28205, Bremen

    J. Rustemeyer

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  1. J. Rustemeyer
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Correspondence to J. Rustemeyer.

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Rustemeyer, J., Thieme, V., Günther, L. et al. Erfahrungen in der chirurgischen Versorgung von Gesichtshautbasaliomen und plastischen Rekonstruktionsverfahren. Mund Kiefer GesichtsChir 9, 220–224 (2005). https://doi.org/10.1007/s10006-005-0626-4

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