Lokalni aksijalni režnjevi u rekonstrukciji ekscizijskog defekta vlasišta u bolesnika uznapredovale životne dobi

Ivan Kovačić, Marijan Kovačić, Zoran Kranjčec

Cilj ovog rada jest prikazati rezultate liječenja rekonstrukcije defekta vlasišta nakon kirurške ekscizije bazocelularnih (BCC) i planocelularnih kožnih karcinoma (PCC) u grupi bolesnika starijih od 80 godina. U retrospektivnu analizu uključili smo devet bolesnika koji su u vrijeme operacije imali tumor veći od 4 cm. Nakon njihove ekscizije nastali defekti su bili širokog raspona, od 40 cm2 do 81,7 cm2 (medijan, C = 63,6 cm2). Dubina im je sezala od denudiranog periosta do tvrde moždane ovojnice. Svi su rekonstruirani s aksijalnim lokalnim režnjevima koji su formirani subgalealnim pristupom s imenovanim opskrbnim žilama, a transfer tkiva je izvršen klizanjem, transpozicijom i rotacijom. Donorsko mjesto je sanirano primarnim zatvaranjem ili upotrebom slobodnoga kožnog transplantata. Oporavak bolesnika je bio brz, uz odsutnost općih komplikacija. Od lokalnih kirurških komplikacija zabilježili smo infekciju s rubnom nekrozom spoja režnja i okolnog tkiva uz prisutnu ekhimozu kod pet bolesnika. Sve su ove komplikacije sanirane tijekom ambulantne njege rane. Upotrebom aksijalnih lokalnih režnjeva uspješno je nadomješten ekscizijski defekt vlasišta velike površine u grupi bolesnika uznapredovale životne dobi, bez obzira na njihovu lošu kvalitetu kože, ožiljke od ranijeg kirurškog zahvata te prisutne komorbiditete. Ova metoda rekonstrukcije tehnički nije zahtjevna, izvodi se u jednom aktu i možemo ju smatrati sigurnom za sve nivoe i lokalizacije defekta vlasišta.

The aim of this paper is to present the results of the treatment of scalp defect reconstruction after surgical excision of basal cell (BCC) and squamous cell skin carcinoma (PCC) in a group of patients older than 80 years. In the retrospective analysis, we included nine patients who at the time of surgery had a tumor size greater than 4 cm. After their excision, the resulting defects had a wide range from 40 cm2 to 81.7 cm2 (median, C = 63.6 cm2). Their depth reached from the denuded periosteum to the dura mater. All were reconstructed with axial local flaps that were formed through a subgaleal approach with named supply vessels, and tissue transfer was performed by sliding, transposition, and rotation. The donor site was repaired by primary closure or by using a free skin graft. The patients’ recovery was quick, with no general complications. Among the local surgical complications, we recorded infection with marginal necrosis of the junction of the flap and the surrounding tissue with ecchymosis present in five patients. All these complications were resolved during outpatient wound care. Using axial local flaps, a large excision scalp defect was successfully replaced in a group of patients of advanced age, regardless of their poor skin quality, scars from earlier surgery, and existing comorbidities. This method of reconstruction is not technically demanding, it is performed in one act and we can consider it safe for all levels and localizations of scalp defects.