摘要
目的总结修复大面积头皮缺损的经验及教训,探讨外科修复大面积头皮缺损的方法及适应证。方法对头皮撕脱伤头皮保存完整者急症实施吻合血管的头皮再植,对保存不完整者尽可能寻找血管实行部分再植;对头皮缺损但帽状腱膜完整者根据污染情况实施急症植皮术或二期植皮修复;对伴有大面积颅骨外露者应用带蒂斜方肌皮瓣或游离皮瓣移植修复。结果再植头皮大部坏死1例,部分坏死2例;带蒂斜方肌皮瓣部分坏死1例,寄养游离股前外侧皮瓣完全坏死1例,其余皮瓣及植皮均全部成活,颅骨完全覆盖。结论对急性期头皮撕脱伤应尽力予以再植;对帽状腱膜完整者植皮修复简单易行,效果良好;带蒂斜方肌皮瓣血运可靠,适应于修复头顶枕部的缺损;游离股前外侧皮瓣修复颅骨大面积外露具有供皮量大、抗感染能力强的优点,适用于颅骨长期外露的患者。
Objective To summarize the experience of our department in surgical treatments of oversized scalp defects during last 10 years. Methods The avulsed scalps were replanted in emergency phase;The scalp defects with holy galea aponeurotica were recovered by free skin transplantation;The over- sized exposed skull was covered by trapezius musculo-eutaneous flap with pediele or free transplantation of anterolateral thigh flap. The area of flaps was （16 ～ 32）cm × （8 ～ 25 ）cm. Results Replanted scalp was subtotal necrosis in 1 case, partial necrosis in 2 cases ; trapezius musculo-cutaneous flap was partly necrosis in 1 case and total necrosis of the free anterolateral thigh flap in 1 case ; other flaps or replanted scalps survived completely and there was no vascular crisis, the exposed skull was covered thoroughly. Conclusions The avulsed scalps should be replanted with most efforts ; Free skin transplantation was ideal in recovering the scalp defects with holy galea aponeurotica; The trapezius musclo-cutaneous flap was the best choice for recovering the scalp defects in parietal and occipital region. The free anterolateral thigh flap can provide large coverage for the scalp defects, which was an optimal choice for the management of the oversized exposed skull.
出处
《中华损伤与修复杂志（电子版）》
CAS
2007年第5期275-277,共3页
Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)
