■症例報告
補助療法を併用した最小限の切除とエステティックユニットを考慮した再建により良好な治療アウトカムを得た上口唇の皮膚原発リンパ腫の1例
岩永 洋平1, 桑原 大彰1, 小川 令2, 赤石 諭史1
1日本医科大学武蔵小杉病院形成外科
2日本医科大学付属病院形成外科・再建外科・美容外科
Consideration of Facial Aesthetic Units When Resecting Malignant Facial Lesions
Yohei Iwanaga1, Hiroaki Kuwahara1, Rei Ogawa2 and Satoshi Akaishi1
1)Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Musashi Kosugi Hospital
2)Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School
When resection of a malignant facial lesion is followed by reconstruction, the functional aspects and appearance of the face must be carefully considered. Reconstruction of facial aesthetic units requires a negative oncological margin. Herein, on the basis of our experience of reconstruction after resecting a skin tumor in the upper lip, we describe the optimal range of resection for a malignant facial tumor and optimization of reconstruction. A 68-year-old man with an elevated lesion on the upper right lip and nasal cavity consulted a dermatologist at our hospital. A biopsy revealed malignant fibrous histiocytoma, and the patient was referred to our department for radical treatment. After excising the tumor to ensure a macroscopic negative margin, we reconstructed the upper lip and nasal wing by using an Abbe's flap and nasolabial orbicularis oris myocutaneous flap, respectively. The recommended method for excising a soft tissue sarcoma on the face requires removal of many free rims or tissues that are difficult to replace, which can result in extremely low postoperative quality of life for the patient. As an alternative to definite wide-margin excision, we recommend that radical treatment by marginal excision and adjuvant therapy should be considered when indicated. In addition, when excising tumors in areas of aesthetic importance, wide-margin excision may not always be necessary. Reconstruction of each aesthetic unit after individual excision may help achieve a satisfactory aesthetic result.
日医大医会誌 2022; 18(1), 109-112
Key words
aesthetic unit, reconstruction, malignancy, upper lip, surgery
Correspondence to
Yohei Iwanaga, Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
E-mail：y-iwanaga@nms.ac.jp
受付：2021年6月24日 受理：2021年8月17日 |
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