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[Advanced epitheliomas of the face: when to stop?].
Ann Chir Plast Esthet. 1998 Aug; 43(4):383-99.AC

Abstract

Progress in plastic surgery has allowed an ever increasing extension of the indications for facial reconstruction. Although carcinomas are now detected earlier and earlier, the practitioner is nevertheless faced, several times during his working life, with "historical" cases. Although it is fairly rare to observe long-term progression of squamous cell carcinomas, basal cell carcinomas can take on considerable proportions due to their very low metastatic risk. In these situations, the dilemma between conservative management and performing an inevitably major procedure is never easy to resolve. Moreover, it is often the discomfort experienced by the patient's family which encourages him to accept the operation. The objective of the procedure is more often aesthetic rather than curative, although this latter objective must always be attempted. Consequently, the practitioner should never hesitate to defer reconstruction for several months in order to ensure reliable local surveillance. The value of epitheses is clearly established in this situation. When a reconstruction can be performed, "major" measures are generally necessary, making use of all of the regional or even distant plastic surgery techniques used for facial surgery. However, microsurgery is a last resort indication, which should only be used when the various pedicle flaps have been exhausted. The microsurgical delay technique (Jean-Marie Servant's "apple turnover" technique) is particularly useful in these situations. In the light of seven clinical cases, the authors try to define the essential concepts of this type of management. In fact, the respective limits of active intervention and conservative management are defined by each surgeon's common sense and experience. The constant improvement of the quality of epitheses make them the current treatment of choice for the restoration of extensive defects. Lastly, one of the main factors to be considered before taking any treatment decision is the psychology of these patients, as it is always difficult to explain the discovery of lesions at this advanced stage.

Authors+Show Affiliations

Service de Chirurgie Plastique Reconstructrice et Esthétique, Chirurgie de la Main et Microchirurgie, Hôpital du Tondu, CHU Groupe Pellegrin-Tondu, Bordeaux, France.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

fre

PubMed ID

9926471

Citation

Martin, D, et al. "[Advanced Epitheliomas of the Face: when to Stop?]." Annales De Chirurgie Plastique Et Esthetique, vol. 43, no. 4, 1998, pp. 383-99.
Martin D, Pélissier P, Barthélémy I, et al. [Advanced epitheliomas of the face: when to stop?]. Ann Chir Plast Esthet. 1998;43(4):383-99.
Martin, D., Pélissier, P., Barthélémy, I., & Mondié, J. M. (1998). [Advanced epitheliomas of the face: when to stop?]. Annales De Chirurgie Plastique Et Esthetique, 43(4), 383-99.
Martin D, et al. [Advanced Epitheliomas of the Face: when to Stop?]. Ann Chir Plast Esthet. 1998;43(4):383-99. PubMed PMID: 9926471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Advanced epitheliomas of the face: when to stop?]. AU - Martin,D, AU - Pélissier,P, AU - Barthélémy,I, AU - Mondié,J M, PY - 1999/2/2/pubmed PY - 1999/2/2/medline PY - 1999/2/2/entrez SP - 383 EP - 99 JF - Annales de chirurgie plastique et esthetique JO - Ann Chir Plast Esthet VL - 43 IS - 4 N2 - Progress in plastic surgery has allowed an ever increasing extension of the indications for facial reconstruction. Although carcinomas are now detected earlier and earlier, the practitioner is nevertheless faced, several times during his working life, with "historical" cases. Although it is fairly rare to observe long-term progression of squamous cell carcinomas, basal cell carcinomas can take on considerable proportions due to their very low metastatic risk. In these situations, the dilemma between conservative management and performing an inevitably major procedure is never easy to resolve. Moreover, it is often the discomfort experienced by the patient's family which encourages him to accept the operation. The objective of the procedure is more often aesthetic rather than curative, although this latter objective must always be attempted. Consequently, the practitioner should never hesitate to defer reconstruction for several months in order to ensure reliable local surveillance. The value of epitheses is clearly established in this situation. When a reconstruction can be performed, "major" measures are generally necessary, making use of all of the regional or even distant plastic surgery techniques used for facial surgery. However, microsurgery is a last resort indication, which should only be used when the various pedicle flaps have been exhausted. The microsurgical delay technique (Jean-Marie Servant's "apple turnover" technique) is particularly useful in these situations. In the light of seven clinical cases, the authors try to define the essential concepts of this type of management. In fact, the respective limits of active intervention and conservative management are defined by each surgeon's common sense and experience. The constant improvement of the quality of epitheses make them the current treatment of choice for the restoration of extensive defects. Lastly, one of the main factors to be considered before taking any treatment decision is the psychology of these patients, as it is always difficult to explain the discovery of lesions at this advanced stage. SN - 0294-1260 UR - https://www.unboundmedicine.com/medline/citation/9926471/[Advanced_epitheliomas_of_the_face:_when_to_stop]_ L2 - https://medlineplus.gov/skincancer.html DB - PRIME DP - Unbound Medicine ER -