大中面积头皮缺损的整形修复方法探讨(附58例临床报告)

Investigate of repair and reconstruction methods of large and medium size scalp defects:clinical report of 58 cases

目的探讨寻求大中面积头皮缺损最佳治疗修复方法。方法回顾9年来58例大中面积头皮病变的修复方法,包括：游离皮片移植;局部旋转皮瓣、推进皮瓣;头皮常规、超量扩张术;超长蒂斜方肌肌皮瓣或吻合血管的游离背阔肌肌皮瓣移植。结果 18例应用皮片移植修复;15例采用局部皮瓣转移修复,1例发生远端小面积坏死;2例术后随诊5个月后复发,再次行肿瘤扩大切除术,采用吻合血管的游离背阔肌肌皮瓣修复;16例采用头皮超量扩张术;9例吻合血管的游离背阔肌肌皮瓣移植修复,皮瓣全部成活,术后根据病理性质选择放化疗。随访1~5年8例恶性肿瘤无复发,1例肿瘤复发转移死亡。结论根据头皮病理性质确定切除的范围及深度,良性病变尽可能选择头皮扩张修复可达到毛发的美容重建,恶性肿瘤病变范围大、深度深者选择肌皮瓣,以利于术后耐受放疗。选择正确的修复方法是治疗头皮肿瘤和病变的关键。

Objective To investigate the best treatment and reconstruction method according to the pathological characters,size and depth of the defects of the scalp.Methods Review the reconstruction methods of large and medium size scalp defects in 58 cases during 9 years,including： skin graft,local and adjacent skin flap,regular and modified soft-tissue expansion,pedicled trapezius musculo cutaneous flap and free latissimus dorsi musculo cutaneous flap.Results From January 2002 to January 2011,18 cases were performed skin graft,15 cases were performed local flap,16 case of giant benign tumors tissue expander,9 cases of maligment tumors free latissimus dorsi flap.All the skin grafts and flaps survived except one local flap of distant necrosis,two tumor recurrence with extensive resection and free flap reconstruction after 5 months,one died of cancer in the following-up.Conclusion Decide the resection size and depth of the scalp disease according to the pathological characters.Soft-tissue expansion could be used in the scalp reconstruction after resection of benign tumors preferentially,while musculo cutaneous flaps are considered to reconstruct the huge defects after the resection of maligment tumors.Choosing an appropriate reconstructive method is the key to the treatment of scalp tumor and pathological disease.