Round Block Maneuver for Curing Facial Malignancy: An Innovative Idea

圓筒式縫合的創新應用於顏面皮膚癌之癒合

林鴻儒(Hung-Ru Lin)

《南臺灣醫學雜誌》 7卷2期 (2011/12) Pp. 112-118

https://doi.org/10.6726/MJST.201112_7(2).0005

摘要

自2004年2月至2008年12月，我們從28例顏面皮膚惡性腫瘤患者中，歸納出19位年齡自39到87歲，平均68歲的病人，共收集使用24次改良的袋線式縫合手術方式重建顏面惡性腫瘤廣泛切除後的缺陷。簡單，省時又快速經濟的步驟始自圓塊式切除，立即用大口徑尼龍線直接自真皮層以袋線逢合法，順著皮膚最小張力線路徑（RSTL），直接包夾關閉傷口缺損，至少靜候六週再將這駐留縫線移除。儘管初期會對五官造成扭曲變形，但最終都得到相當令人滿意的功能與美觀上之治療成效。尤其對應用在高齡族群好發的基底或鱗狀細胞癌之治療重建上，圓筒式根除術式甚至於只要局部麻醉下，速戰速決直接關閉傷口，就能一氣呵成完成重建，且最終都能在保留原有相關解剖方位的立意下，即使須再行二次切除手術，亦能在局部麻醉下，確切得到根治療效。此一改良手術不僅相當簡易快速、有效，也是個安全、值得推廣的術式選擇。

關鍵字

圓筒式術法 ； 基底細胞癌 ； 鱗狀細胞癌 ； 真皮袋線式縫合

並列摘要

After radical excision of facial skin malignancy, we adopted one simple, rapid and efficient round block approach to restore facial continuity and delivered excellent functional and cosmetic results. From Feburary 2004 to December 2008, 19 cases were enrolled from 28 facial skin malignancies, and 24 sessions of round block maneuver were executed. Median age was 68, ranging from 39 to 87, years old, After wide ablation leading to round-like defects, we used large-caliber nylon, with minimal or no undermining, to create deep dermal purse string suture, termed round block maneuver (RBM), to close the defects. Despite distortion of facial appearance initially, the staying suture was meant to stay for a minimum of 6 weeks and was removed at an outpatient base. For aged people predisposed to basal cell or squamous cell carcinoma, the RBM gained the surgical advantage of least time spent, minimal destruction of surrounding tissue and no impeding further reconstructive possibilities. We achieved cure with fine functional and cosmetic results, even under local anesthesia. This surgical procedure should deserve an innovative application.

並列關鍵字

round block technique ； basal cell carcinoma ； squamous cell carcinoma ； dermal pursestring suture