摘要
目的探讨应用皮肤软组织扩张器(下称扩张器)制作的扩张皮瓣修复钛网颅骨成形术后钛网外露创面的临床效果。方法采用回顾性观察性研究方法。2015年4月—2019年10月,空军军医大学第一附属医院收治13例钛网颅骨成形术后钛网外露创面患者,其中男10例、女3例,年龄18~70岁,钛网外露出现时间为钛网颅骨成形术后3个月~4年,钛网外露创面面积:1.5 cm×0.6 cm~6.3 cm×6.0 cm。Ⅰ期于钛网外露创面周围边缘1 cm以远的正常头皮下置入1个或2个额定容积50~200 mL方形扩张器,注水时间2~3个月,总注水量为扩张器额定容积的1.6~2.0倍。Ⅱ期行扩张器取出及扩张皮瓣(面积为4.1 cm×1.8 cm~9.1 cm×7.9 cm)转移修复钛网外露创面。统计扩张器置入部位,扩张皮瓣转移形式,术后钛网外露部位创面愈合情况、扩张皮瓣成活情况;随访头部切口瘢痕及外形情况。结果本组患者中7例扩张器置入部位为颞部、6例为顶部。11例患者扩张皮瓣推进转移,2例患者扩张皮瓣易位转移。本组患者术后均成功保留钛网且头部创面均愈合。1例患者扩张皮瓣尖端坏死通过换药处理后治愈,12例患者扩张皮瓣转移后全部成活。术后12个月随访,本组患者外露钛网保留,切口愈合好,切口瘢痕隐蔽,头皮毛发生长良好,头部外观较佳。结论采用扩张皮瓣修复钛网颅骨成形术后钛网外露创面,能有效地覆盖创面并保留外露钛网,获得良好的功能和外形。
Objective To explore the clinical effects of expanded flap made by skin and soft tissue expander(hereinafter referred to as expander)in repairing the wounds with exposed titanium mesh after cranioplasty with titanium mesh.Methods A retrospective observational study was conducted.From April 2015 to October 2019,13 patients with wounds with exposed titanium mesh after cranioplasty with titanium mesh were admitted to the First Affiliated Hospital of Air Force Medical University,including 10 males and 3 females,aged 18 to 70 years.Exposure of titanium mesh occurred 3 months to 4 years after cranioplasty with titanium mesh.The wound area of exposed titanium mesh ranged from 1.5 cm×0.6 cm to 6.3 cm×6.0 cm.In the first stage,one or two square expanders with rated capacity of 50-200 mL were placed under the normal scalp 1 cm away from the edge of the wound surface of exposed titanium mesh.The water injection time was 2 to 3 months with the total water injection volume being 1.6 to 2.0 times of the rated capacity of expander.In the second stage,the expander was removed and the expanded flap(size ranging from 4.1 cm×1.8 cm to 9.1 cm×7.9 cm)was transferred to repair the wound of exposed titanium mesh.The placement site of the expander,the transfer form of the expanded flap,the postoperative wound healing of the titanium mesh exposed site,and the survival of expanded flap were recorded.The scar of the head incision and the appearance of head were followed up.Results Among the patients in this group,the expanders of 7 were placed in the temporal region,while the other 6 were placed at the top.The 11 patients were treated with advanced expanded flap,while the other 2 patients were treated with pedicled expanded flap.The head wounds of patients in this group successfully healed with retaining of the titanium mesh.The wound was healed after dressing change in 1 patient with necrosis at the tip of the expanded flap.The expanded flaps of 12 patients survived after transfer.Patients in this group were followed up for 12 months after surgery,the exposed titanium meshes were retained,the incisions healed well with the scars concealed,the hair on the scalp grew well,and the appearance of head was comparatively good.Conclusions Using expanded flap in the repair of the wounds with exposed titanium mesh after cranioplasty with titanium mesh can effectively cover the wound and retain the titanium mesh,achieving good function and appearance.
作者
计鹏
胡大海
韩夫
杨晨
张智
佟琳
张月
韩军涛
陶克
Ji Peng;Hu Dahai;Han Fu;Yang Chen;Zhang Zhi;Tong Lin;Zhang Yue;Han Juntao;Tao Ke(Department of Burns and Cutaneous Surgery,Burn Center of PLA,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2021年第8期752-757,共6页
Chinese Journal of Burns
关键词
扩张术
外科皮瓣
伤口愈合
颅骨成形术
钛网外露
Dilatation
Surgical flaps
Wound healing
Cranioplasty
Titanium mesh exposure
