顔面血管腫の形成外科的治療

PLASTIC SURGICAL MANAGEMENT OF FACIAL HEMANGIOMA

I．はじめに

　血管腫は，ごくありふれた疾患であり，診断も多くの場合容易であるが，その治療に関しては，放射線照射^7）8），凝固剤注入^16）あるいは真皮内に色素剤を刺青する^{14）17）23）}など，種々試みられているものの，これらは局在的あるいは組織学的には治癒しても患者の希望である整容という点で，今一歩という段階であり^9），時には，治療したことにより醜形を残すことさえある。

　とくに，顔面の血管腫は患者に強い劣等感を与えていることが多い。われわれの外来を訪ずれる患者は，この疾患を自分の身体の一部から取り除くことによつて，劣等感より解放され，新しい自分の人生を踏み出そうとする動機をもつたものが多い。実際に治療した結果においても，この事実は証明されている（症例7）。したがつて，本症は機能的に障害がなくても，形成外科的治療の適応となると考えている。

Seven cases of facial hemangioma treated with plastic surgery were reported. They were classified as 1) simple angioma, 2) strawberry mark, 3) portwine stain, and 4) cavernous angioma. While the former two have tendency to spontaneous involution and should he observed without any treatment, the latter two can not be expected for spontaneous cure and become indication of plastic surgical management.

Plastic surgical methods have many merits comparing with other methods, in estimation of postoperative effect, that is, in shortening of therapeutic duration and cosmetic improvement, though plastic surgery has some limitation due to size and position of lesions.

Resection showed excellent results in operative methods, and often serial resection was applied. Subcutaneous tumer resected without removal of skin left the least postoperative scar.

Local flap method also showed good results, the example of which was cervical flap for portwine stain on the cheek.

Indication of free grafting of the skin should be careful, because its results were not good in many cases cosmetically.

Another methods, for example, irradiation method, injection of coagulant or those combined with operation also showed excellent results, but they should be performed conservatively.