头皮缺损97例治疗分析

Exploration of the Treatment for 97 Cases of Scalp Defects

目的探讨头皮撕脱伤及头皮烧伤后头皮缺损治疗的方法及效果。方法回顾本院1994年8月—2007年12月对97例头皮撕脱伤及头皮烧伤后头皮缺损的治疗情况,对颅骨外露、颅骨全层烧伤等采用颅骨钻孔、培育肉芽组织、中厚皮片移植,皮管带蒂皮瓣移植,局部转移皮瓣移植,皮肤扩张器应用后皮瓣转移等消灭头皮缺损。结果颅骨外露宜采用颅骨钻孔、肉芽生长后再行中厚皮片移植,孔径1～2mm,孔间距1～1.5mm;颅骨坏死宜采用局部皮瓣移植或皮管带蒂皮瓣移植;颅骨外有帽状腱膜等软组织存在,可直接用中厚自体皮移植,但无头发。皮肤扩张器扩张正常头皮后再转移皮瓣移植消灭颅骨外露,虽然治疗疗程长,但毛发正常生长,外观好。结论头皮撕脱伤的不同病例,应采用不同的治疗方法,才能达到最好的治疗效果。

Objective To discuss scalp avulsion defects and the methods and effects of the treatment for the scalp defect from burning. Methods A retrospective analysis is made on different scalp avulsion defects and burned injuries in our hospital since 1994. As for skull exposure and its total burn,cures are： sphenotresia,nurture of granulation tissue,transplantation of intermediate-thickness skin graft;transplantation of skin flap with pedicle skin tube;transplantation of skin flap by regional metastasis;and flap transfer after application of skin expander. Results Skull exposure can be treated by sphenotresia,nurture of granulation tissue,and then transplantation of intermediate-thickness skin graft,with 1-2mm aperture and 1-1.5mm hole pitch. Skull necrosis is better cured by regional transplantation of skin flap or transplantation of skin flap with pedicle skin tube. Transplantation of intermediate-thickness self-body skin can be taken when there are soft tissues like galea aponeurotica around the skull,but resulting in no hair. Expanding normal scalp with the skin expander and then transplantation by flap transfer can be used to remove skull exposure,which takes a long course of treatment,but the hair can grow well. Conclusion Different cases of scalp defects should be treated in different ways,in order to achieve the best therapeutic effect.