Споредбена анализа на реконструктивни техники, кожни трансплантати и резанки, применети за затворање на дефекти по отстранување на немеланомски кожни карциноми во пределот на носот

Abstract

Introduction Basal cell carcinoma accounts for the majority of non-melanoma skin cancers, and squamous cell carcinoma is the second most common type. The gold standard for the treatment of these cancers is the surgical removal of them into healthy surrounding tissue. From the facial region, the nose is the most anatomically exposed part, and as such has great significance. The most common localization of the NMSC is in this region. After the surgical excision of these malignancies, the repair of defects is a challenge for every surgeon in the past and today. Materials and methods This study included 160 patients. They were divided into two large groups of 80 patients each with respect to the localization of the defect: Group I - patients with a malignant lesion in the upper part of the nose consisting of lateral walls and dorsum, and group II - patients with a malignant lesio in the lower part of the nose consisted of nasal tip, nasal lateral wings and columella. Each patient group was further subdivided into 4 subgroups of 20 patients according to the reconstructive technique. The study lasted 2 years and all patients were operated on during 2017 and 2018. Results Statistical analysis of this study shows that the gender of patients does not affect any of the outcomes, and the average age of patients is over 60 years. Basal cell carcinoma is dominant among the skin cancers on the nose and is histopathologically verified in 85% of the subjects. Concerning the link between the complications of reconstructive techniques with diabetes and cigarette smoking, it has been concluded that there is a possible association between the complications associated with skin grafts and smoking of cigarettes on the one hand and the complications of local flaps and diabetes on the other. The main purpose of this doctoral dissertation was to perform a comprehensive analysis of the four sets of reconstructive techniques in relation to postoperative scar evaluation with respect to the POSAS observer and patient scale. This was evaluated in the upper and lower half of the nose with respect to the size of the defect larger than 1.5cm and smaller than 1.5 cm. All of this analysis took into account the days of hospitalization and complications after scar reconstruction and an algorithm for reconstruction of the skin defects in the nose area was developed with the aim of a fast, easy, aesthetically superior reconstruction. Conclusion The reconstructive techniques analyzed in this study are an effective solution for nasal area defects if selected appropriately with respect to the localization and size of the defect. The composite skin graft provides the opportunity to be used as a way of reconstruction and can completely replace the full thickness skin graft in the defect closer in the lower half of the nose.