Plastic Surgery is now a formidable ally to repair some physical deformities. It restores the joy of living persons mined by their complex. It is also capable of repairing the skin of people who were unable to withstand repeated sun exposure, which resulted in skin lesions.

Micrographic Surgery Skin: Reassuring and Refined Aesthetic

Rare truly innovative technique for sixty years in one area – reconstructive plastic surgery – where progress is exponential. However, Surgery Micrographic was first a revolution across the Atlantic. This medicine is meant to restore health and beauty of his patients especially after sun exposure.

Because they are sensitive and priority areas of the affected face (eyebrows, eyelids, nose, lips and ears) are those for which it is vital to maintain functional abilities and obtain optimal cosmetic result. These interventions are particularly relevant to Micrographic Surgery Skin.

The Indications for Micrographic Surgery for Skin Tumors

Basal Cell Carcinoma (BCC) is the skin cancer most often. It occurs in most cases after 50 years but also occurs in patients becoming younger. The major causative factor is the intermittent sun exposure more involved than the chronic. He rarely metastasis but can cause significant tissue destruction.

“AMSTRONG BK, Krick A. Epidemiology of sun exposure and skin cancer. Cancer Surveys, 1996, 26: 133-153″

Other indications of the Cutaneous Micrographic Surgery are squamous cell carcinomas, melanomas Dubreuilh, sarcoma skin of Darier and Ferrand tumors Merckel.

The Basic Clinical Pathology

What characterizes the various skin lesions such as basal cell carcinoma or melanoma, apart from their size and their depth, their extension, lateral and deep, may be invisible to the naked eye with the risk of range from totally unpredictable. This extension acts on a three-dimensional mode, not concentric and totally unbalanced. In the case of recurrent tumors that have already been excised and covered by a flap, this extension may be more important and sometimes have deeply penetrated the fabric.

In such a situation and know exactly their extension, it is advisable to have recourse to the Cutaneous Micrographic Surgery because of inadequate excision margins exhibit a recurrence. Conversely, excessive margins imply an unnecessary loss of healthy skin with functional and aesthetic consequences.

The method of Micrographic Surgery associated with skin examination “extemporaneous” in 2 and 3D time. Unlike conventional surgery levying areas considered suspicious by the surgeon estimates downplaying a percentage of the periphery of the lesion, micrographic surgery can view all of the tumor in 3D. The Mohs Micrographic Surgery involves the microscopic analysis of the number of excision mapping to pinpoint the location of the tumor on histological examination. The mapping of markers used to identify the edges of the room of circumcision, applied “extemporaneous.” This means that the tissue removed is frozen and cut into “pancakes” very thin horizontal surface of the skin until the entire room. The serial sections allow the doctor anatomical pathologist and the surgeon to visualize the entire extent of the tumor in 3 D. If the tumor has not been entirely removed, the markers mapping to help locate the “gut tumor” with, if necessary, further surgery accurately. And so on, this second fragment will be analyzed similarly in depth and edges. This approach allows a reduction of excision margins faster and ensures complete removal of the tumor.

The Micrographic Surgery for Skin Tumors

It is the desire of practitioners to reconstruct the face by ensuring at all costs total excision of the lesion and to guarantee the low rate of recurrence that has thought and work on a new surgical technique, comfortable and reassuring This induces a shorter intervention for the patient:

* Assess the extension of tumor invasion is often impossible clinically and poses the problem of excision margin the most appropriate (safety margin) which is to preserve as much healthy tissue in areas “at risk”.
* The size of this “margin” depends on its clinical appearance and histological
reviews in classical histology does not have control of the entire circumference and depth of excision.
Only histological analysis certified by frozen section examination allows the practitioner to visualize the entire margin, allowing it to precisely locate areas residual tumor.
* Find the ideal compromise between the risk of not being healthy tissue and the need to spare the healthy skin around the tumor, which is desirable for a functional and aesthetic reconstruction optimal.
* Minimize the trauma of surgery by limiting the visible scarring.

Patients are relieved not to suffer the inconvenience and risks of general anesthesia and thus prevent hospitalization.

Implementation for a Safer and Beautiful Reconstruction

The action takes place mostly under local anesthesia as an outpatient and may last less than an hour in experienced hands. It must or may be performed at the same time or deferred pending the outcome histological, – is the technique that our practitioner privileges – especially in difficult cases such as locations at risk: the nostrils, peri-orbital and auricular , recurrent tumors.

A French study showed a recidivism rate is very satisfactory because of 0.7 P. 100 to 4 years with surgery associated with the frozen section.