๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Results and recurrence rate
Results and recurrence rate
A recent meta-analysis analyzed three types of closures after wide local excision.38 Recurrence rates were identified with four primary closure studies, seven skin flap studies, and eight skin graft studies. The average recurrence rates were as follows: primary closure, 15% (95% CI, 0โ72%); skin flaps, 8% (95% CI, 2.0โ16.0%); and skin grafts, 6% (95% CI, 0.0โ24.0%). There was a high and statistically significant heterogeneity within the primary closure (I2 = 96%) and skin graft groups (I2 = 93%). Secondary intention healing after wide excision has not been sufficiently studied to draw conclusions. In general, lower rates of disease progression after wide resection, as well as a longer disease-free interval, may be achieved with the use of adjuvant biologic therapy.46
Complications
The postoperative complication rate after wide excision was studied for the following closure techniques: primary closure, flap reconstruction, STSG, or healing by secondary intention.31,34,47 An overall complication rate of 17.8% was reported in a group of 106 patients with mixed reconstructive methods.34 Most of the complications were minor,
such as suture dehiscence (5.4%), postoperative bleeding/hematoma (5.0%), wound infection (3.7%), and contracture (1.7%).34 Additionally, the incidence of complications over all reconstructive methods was studied by Bieniek et al. in 57 patients: pain (30%), wound infection (11%), contractures (7%), bleeding causing hypovolemia (5%), and excessive proliferation of granulation tissue (2%) were described.31 The (partial) loss of both flap reconstructions and skin grafts have been poorly studied. The complications and recurrence rates of wide excision followed by secondary intention healing have not been extensively studied. However, clinical experience suggests that the recurrence rate is lower than mentioned in the literature and complications of secondary intention healing are rare.