Artificial Dermis (Terudermis^®) Followed by Split-Thickness Skin Graft Might be a Reliable Option for Surgical Reconstruction Following Spindle Cell Squamous Cell Carcinoma Excision and Post-Reconstruction Radiotherapy - A Case Rreport

梭狀細胞鱗狀細胞癌手術切除術後需術後輔助放療的傷口，使用人造真皮（Terudermis^®）隨後施行分層厚度皮膚移植可能是個可靠的傷口重建選擇－個案報告

徐國峰(Kuo-Feng Hsu) ； 陳俊宇(Chun-Yu Chen) ； 瞿子翔(Tzi-Shiang Chu) ； 劉虹慧(Hung-Hui Liu) ； 張鈞凱(Chun-Kai Chang) ； 吳建儒(Chien-Ju Wu) ； 王啟宇(Chi-Yu Wang) ； 周昌益(Chang-Yi Chou) ； 林進達(Chin-Ta Lin) ； 戴念梓(Niann-Tzyy Dai) ； 曾元生(Yuan-Sheng Tzeng) ； 陳錫根(Shyi-gen Chen) ； 陳天牧(Tim-Mo Chen) ； 王志信(Chih-Hsin Wang)

《臺灣整形外科醫學會雜誌》 27卷3期 (2018/09) Pp. 206-213

摘要

Background: Spindle cell squamous cell carcinoma is a rare variant of squamous cell carcinoma, and often presents with deep infiltration into adjacent tissue. Treatment includes wide excision or Mohs micrographic surgery, which creates wounds requiring secondary reconstruction. For high-risk lesions, adjuvant radiotherapy is often required and can pose a challenge for reconstruction. The value of dermal regeneration templates such as the Integra^® artificial dermis for trauma, burns, and oncological reconstruction has previously been shown. However, only a few studies have described the effect of radiation on artificial dermis; none investigated Terudermis^® (Terumo Corp., Tokyo, Japan). Materials and Methods: We present a patient with a huge spindle cell squamous cell carcinoma in the right upper arm in whom Terudermis^® was used followed by skin grafting for wound reconstruction and postoperative radiotherapy for locally invasive disease. Result: Only mild erythema of the grafted skin was noted during radiotherapy period. There was no abnormal scarring or skin breakdown, and a soft grafted skin area with a good aesthetic appearance was observed after 1 year. Conclusions: The patient's course shows that Terudermis^® is a good option for reconstructing wounds created by skin cancer excision; it also exhibits good radiation tolerance for patients requiring post-reconstruction radiotherapy.

關鍵字

artificial dermis ； Terudermis^® ； spindle cell squamous cell carcinoma ； surgical reconstruction ； post-reconstruction radiotherapy ； adjuvant radiotherapy

並列摘要

背景：梭狀細胞鱗狀細胞癌是鱗狀細胞癌的一種罕見的變體，並且往往深入浸潤鄰近組織。治療方式包括廣泛切除或莫氏顯微外科手術，造成需要二次重建的傷口。對於高危險病變，術後往往需要輔助放療，並可能對重建構成挑戰。真皮再生模板，例如Integra^®人造真皮，在創傷，燒傷和腫瘤傷口重建領域已被證明其應用價值。然而，只有少數研究調查了放射治療對人造真皮的影響；目前並無研究針對Terudermis^®人造真皮(Terumo Corp., Tokyo, Japan)對於放射治療的容忍度有所探討。材料和方法：我們提出一例個案報告。患者的右上臂發現一個巨大的梭形細胞鱗狀細胞癌，在廣泛性切除手術後，我們使用Terudermis^®覆蓋傷口，而兩週後進行皮膚移植，並施以術後局部放射線治療以治療腫瘤局部浸潤病灶。結果：在放射線治療期間僅觀察到移植區域上有輕度紅斑。放射線治療後沒有不正常的疤痕或皮膚破損，1年後傷口具有良好外觀及柔軟的疤痕。結論：此個案報告顯示Terudermis^®可能成為重建皮膚癌切除後傷口重建的選擇之一；尤其對需要傷口重建後放療的患者也具有良好的放射耐受性。