悪性腫瘍切除後の顔面再建修正術

Facial Reconstructive and Touch-Up Surgery Following Surgical and Adjuvant Treatment Against Malignant Tumor

はじめに

　顔面の再建・修正手術を通して痛感するのは，顔は全体をもって顔であることを認識し，細部にとらわれ過ぎないことである。患者の主訴は，一部の瘢痕や陥凹など局所の変形や，口唇閉鎖不全などの一部の機能障害のこともあるが，それだけ治療をしても十分に満足してもらえないことが多い。顔全体もしくは，少なくともパーツ全体を良くするつもりで治療計画を立てたほうがよい。

　ここでは，悪性腫瘍切除後ならではの特徴，顔面再建術の治療方針，具体的な手技と症例を紹介する。

　Reconstructive surgery on the face after malignant tumor extirpation, including secondary revision, requires a specific focus on ensuring balance of the entire face, not just preventing local deformity.

　Facial reconstruction can be divided into three steps: construction of the framework, management of the positions of the facial parts, and correction of the surface. Framework reconstruction requires general anesthesia, and thus immediate reconstruction together with extirpative surgery is nearly always preferable. Repositioning of facial elements can be attained through z-plasty or traction methods, but these revision procedures hold some knacks for sufficient results. First, less-invasive surgeries with local anesthesia will encourage patients to accept esthetic procedures. Second, the excision of scars and the reduction of flaps should be avoided until the final surgical session, because the lack of epithelial components often limits further correction. Lastly, concerning the correction of the skin surface, uninsured medical treatments (e.g., CO2 lasers and tattoos) and non-medical products (e.g., cover marks) can be effective.

　As advances in cancer treatment increase patientsʼ survival rates, facial reconstructive surgery and subsequent revisions will become more important for us. Never give up until doing so cannot be avoided.