Use of Composite Auricular Chondrocutaneous Graft for Upper Eyelid Reconstruction in a Patient with Merkel Cell Carcinoma-＂Case Report and Literature Review＂

複合式耳軟骨皮瓣移植應用Merkel細胞癌病患於上眼瞼的重建－病例報告及文獻回顧

陳治有(Chi-Yu Chen) ； 鄭屹喬(Yi-Chiao Cheng) ； 林進達(Chin-Ta Lin) ； 王志信(Chih-Hsing Wang) ； 邱文寬(Wen-Kuan Chiu) ； 李存昌(Chun-Chang Li) ； 陳天牧(Tim-Mo Chen) ； 陳錫根(Shyi-Gen Chen)

《臺灣整形外科醫學會雜誌》 23卷3期 (2014/09) Pp. 284-289

摘要

背景：眼瞼的Merkel細胞癌是一個罕見的皮膚惡性腫瘤，一開始的表現可能會與霰粒腫難以區分；在臨床上建議手術廣泛性的切除以避免局部復發，然而，上眼瞼全層的組織缺損在手術廣泛性的切除後經常會發生。目的及目標：我們治療的策略是要保留病患上眼瞼的外觀以及功能。病人及方法：一名89歲男性3個月前發現在右上眼瞼有一腫瘤並逐漸變大以至於幾乎佔據整個上眼瞼，在組織切片後經由組織病理學分析確立診斷為Merkel細胞癌。在手術廣泛性的切除後，使用複合式耳軟骨皮瓣來重建眼瞼後層，剩餘的眼瞼使用移前皮瓣來覆蓋眼瞼前層。結果：術後眼瞼外觀及功能都能達到不錯的效果，術後也沒有出現緊急的併發症；在術後追蹤一年中沒有發生局部復發，遠端轉移以及溢淚的情況。結論：根據此病例之治療經驗，當較年長的病患其Merkel細胞癌發生在上眼瞼，使用複合式耳軟骨皮瓣移植這種一階段的方法是可實行的。

並列摘要

Background: Merkel cell carcinoma of the eyelid is a rare skin malignant tumor, which may initially mimic chalazion. Surgical wide excision is recommended for control local recurrence clinically. However, reconstruction of a full-thickness defect of the upper eyelid after surgical wide excision is still challenging. Aim and objectives: The main treatment strategy was to preserve the functionality and aesthetic appearance of the upper eyelid. Materials and Methods: In this article, we present a case of an 89-year-old man with this rare tumor, which occupied the near total of the upper eyelid. The tumor mass had formed 3 months before the assessment, and it showed progressive enlargement. The diagnosis of Merkel cell carcinoma was confirmed by histopathological analysis after performing a biopsy. After wide surgical excision of the tumor with adequate margin, a composite auricular chondrocutaneous graft was designed for reconstruction of the posterior lamella and the advanced flap of the residual eyelid was provided for coverage of the anterior lamella of the eyelid. Results: Eyelid contour, eye opening and closure, and aesthetic balance were achieved after the operation. There were no emergent postoperative complications. There was no local recurrence, distant metastasis, epiphora, or donor site morbidity during a one-year follow up. Conclusion: The simple one-stage technique is feasible in elderly patients with Merkel cell carcinoma of the upper eyelid.

並列關鍵字

Eyelid Reconstruction ； Merkel cell Carcinoma