Marjolin's Ulcer: A Preventable Complication of Burns?
Marjolin's Ulcer: A Preventable Complication of Burns?
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DOI：
10.1097/prs.0b013e3181a8082e
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发表时间：
2009-07-01
影响因子：
3.6
通讯作者：
Copcu, Eray
中科院分区：
文献类型：
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作者：
Copcu, Eray
学习目标：学习本文后，学员应能：1。讨论马约林溃疡的临床特点。2.确定马约林溃疡发生的危险因素。3.制定治疗马约林溃疡的手术治疗方案。摘要：马约林溃疡是一种罕见的侵袭性皮肤恶性肿瘤，发生在先前创伤和慢性炎症的皮肤上，尤其是烧伤后。这种临床症状最早是由马约林于1828年描述的。术语“马约林溃疡”已被普遍接受，指的是烧伤造成的疤痕的长期恶性并发症。然而，疫苗接种、蛇咬伤、骨髓炎、毛发脓肿、压疮和静脉淤血也可能导致这种肿瘤。临床上，报告表明，萎缩性和不稳定的疤痕往往会发展成癌症。多种病因与该病有关，包括受损组织释放的毒素、免疫因素、致癌物质，以及其他因素，如刺激、淋巴再生不良、抗体、突变和局部毒素。据报道，经历恶变的烧伤疤痕的发生率为0.77%至2%。身体的所有部位都可能受到影响，但四肢和头皮最常受到影响。有两种变种：急性和慢性。前者，肿瘤发生在损伤后1年内。慢性型较多见，恶变发展缓慢，平均恶变时间为35年。虽然在这些病变中可以看到许多不同的细胞类型，但主要的组织类型是鳞状细胞癌。马约林氏溃疡通常被认为是侵袭性很强的肿瘤，区域转移率较高；根治性切除是治疗的选择，但对于淋巴清扫没有达成共识。马约林的溃疡可能是隐匿性的，往往会导致不良的预后，而死于马约林的溃疡并不少见。精心的伤口护理是预防这些损害的关键一步。(最后一次。重新构造外科手术124：156 E，2009年。)
Learning Objectives: After studying this article, the participant should be able to: 1. Discuss the clinical features of Marjolin's ulcer. 2. Identify the risk factors for the development of Marjolin's ulcer. 3. Develop a surgical management plan for the treatment of Marjolin's ulcer.Summary: Marjolin's ulcer is a rare and aggressive cutaneous malignancy that arises on previously traumatized and chronically inflamed skin, especially after burns. This clinical condition was first described by Marjolin in 1828. The term "Marjolin's ulcer" has been generally accepted to refer to a long-term malignant complication of the scars resulting from burns. However, vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumor. Clinically, reports suggest that atrophic and unstable scars tend to develop into cancer. Various etiological factors have been implicated in the condition, including toxins released from damaged tissues, immunologic factors, cocarcinogens, and miscellaneous factors such as irritation, poor lymphatic regeneration, antibodies, mutations, and local toxins. The incidence of burn scars undergoing malignant transformation has been reported to be 0.77 to 2 percent. All parts of the body can be affected, but the extremities and the scalp are most frequently affected. There are two variants: acute and chronic. In the former, the carcinoma occurs within 1 year of the injury. The chronic form is more frequent and malignancy tends to develop slowly, with an average time to malignant transformation of 35 years. Although many different cell types can be seen in these lesions, the major histological type is squamous cell carcinoma. Marjolin's ulcers are generally considered as very aggressive tumors with a higher rate of regional metastases; radical excision is the treatment of choice, but there is no consensus on lymph node dissection. Marjolin's ulcer can be insidious and often leads to a poor prognosis, and deaths from Marjolin's ulcer are not uncommon. Meticulous wound care is a crucial step in prevention of these lesions. (Plast. Reconstr. Surg. 124: 156e, 2009.)