๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
HISTORY
Originally termed chemosurgery, MMS was developed by Dr Frederic E. Mohs at the University of Wisconsin-Madison and first published in
1941. His original clinical technique involved the application of a zinc chloride paste to cancerous tissue 24โhours prior to surgical removal of the tumor. The paste fixed and isolated the tumor in vivo. Subsequently, the tumor was excised and processed in a manner similar to the technique used today. However, if there were residual tumor at the margins, zinc chloride paste was re-applied to cancerous margins for 24โhours prior to any further tissue resection. These steps were repeated until complete tumor clearance was obtained.
Limitations of this process include a long incubation period and tissue necrosis from the zinc chloride paste which renders wounds unsuitable for surgical reconstruction. The latter led to Dr Mohsโ second major innovation โ an objective analysis of second intention wound healing. Historically, surgical dogma held that second intention healing produced inferior cosmetic results compared to reconstruction, the surgeonโs โfirst intention for healingโ. The acceptable, and at times superior, cosmetic outcome associated with second intention healing, particularly on concave surfaces, imparts its rightful place among valid reconstructive techniques.
Over 40 years ago, the zinc chloride-based, fixed tissue technique evolved into the fresh-frozen tissue technique, which was popularized by Tromovitch and Stegman. The fresh-frozen section technique eliminated the need for the escharotic zinc chloride paste, and it allowed complete tumor clearance via multiple resections in a single day. Furthermore, without a zinc chloride-induced necrotic base, immediate surgical reconstruction could be performed. The fresh tissue technique has now become the standard protocol for MMS.