Background/Objectives: The gold standard of treatment for both melanoma and non-melanoma skin cancers is wide surgical resection to obtain oncological radicality, which occasionally results in functional or aesthetic impairment, potentially affecting quality of life. Despite the increased complexity of the technique, extended duration of hospitalization, and prolonged surgical operative times, microsurgery can facilitate the reconstruction of locally invasive skin cancers following ablative surgery and may yield superior functional and aesthetic outcomes. Consequently, microsurgical reconstruction is more likely to be necessary if a large skin tumor requires excision. However, the impact of this extensive and complex procedure on patients with skin cancer has not yet been fully elucidated. The objective of this research was to critically analyze the utilization of free flap reconstruction subsequent to skin cancer therapy. Through a comprehensive examination of published data, this study aimed to assess the potential benefits and drawbacks associated with this reconstructive approach. Methods: A systematic review of studies that were published from January 2004 to May 2024 was conducted using the MEDLINE online database search. To present an evidence summary and provide a systematic approach and quality assessment, the GRADE®rating was applied to the results. Results: This review summarizes the oncological and clinical data, including previous interventions, adjuvant and neoadjuvant therapies, nodal status, distant metastasis, and follow-up time. Surgical outcome parameters such as healing time, flap survival, revision rate success, and minor and major complications were documented. Along with the findings, a quality assessment of the studies was also provided. Conclusions: This systematic review underscores the extensive use and efficacy of microsurgery for reconstruction after skin cancer excision; however, the literature remains limited by inconsistent reporting of oncological outcomes and the lack of a standardized approach to evaluate the impact of free flap reconstruction on both immediate and long-term cancer-specific results.
背景/目的：黑色素瘤与非黑色素瘤皮肤癌的标准治疗方式是通过广泛手术切除以实现肿瘤学根治，但这可能导致功能或美观受损，进而影响患者生活质量。尽管显微外科技术复杂度高、住院时间延长且手术耗时较长，但该技术能在消融手术后促进局部侵袭性皮肤癌的重建，并可能实现更优的功能与美观效果。因此，当需要切除较大皮肤肿瘤时，显微外科重建的必要性更为突出。然而，这种广泛而复杂的手术对皮肤癌患者的影响尚未完全阐明。本研究旨在批判性分析皮肤癌治疗后游离皮瓣重建的应用情况，通过对已发表数据的全面梳理，评估该重建方式的潜在优势与局限。方法：通过MEDLINE在线数据库检索2004年1月至2024年5月期间发表的研究进行系统综述。为呈现证据总结并提供系统性方法与质量评估，研究结果采用GRADE®评级体系进行分析。结果：本综述汇总了肿瘤学与临床数据，包括既往干预措施、辅助与新辅助治疗、淋巴结状态、远处转移及随访时间。同时记录了手术结局参数，如愈合时间、皮瓣存活率、修复成功率及轻微与严重并发症。研究结果附有相应的质量评估。结论：本系统综述证实了显微外科在皮肤癌切除后重建中的广泛应用与显著疗效；但现有文献仍存在局限性，包括肿瘤学结局报告缺乏一致性，以及缺乏标准化方法来评估游离皮瓣重建对近期与远期癌症特异性结果的影响。
Microsurgical Reconstruction with Free Tissue Transfer in Skin Cancer Patients: A Systematic Review
肿瘤(癌症)患者之家