超长联合皮瓣在头皮缺损合并颅骨外露或缺损中的应用

Ultralong Axial Scalp Flaps Transferring with Split Skin Graft for Repair of Scalp Defect and Skull Exposure or Defect

目的探讨运用超长联合皮瓣+自体大张中厚皮游离移植覆盖供皮区修复与重建大面积头皮缺损伴颅骨外露或缺损的效果。方法回顾2004年5月~2014年3月收治的运用超长联合皮瓣+自体大张中厚皮游离移植覆盖供皮区修复与重建大面积头皮缺损伴颅骨外露或缺损的15例患者,均为实施肿瘤扩大切除或清创术后,头皮缺损面积最大为20 cm×15 cm,颅骨外露最大面积16 cm×10cm,颅骨缺损最大面积11 cm×7 cm。结果 15例患者头部缺损均得到良好覆盖,植皮修复创面根据修复创面情况,于术后10~12天拆包,植皮成活率大于95%,残留创面予换药处理愈合。术后随访1~10年,所植皮片质地良好,无明显瘢痕增生。1例头皮鳞状细胞癌患者术后随访5年,复查无肿瘤复发。1例梭形细胞肉瘤患者术后2年肿瘤复发、转移死亡。7例Ⅱ期通过扩张器植入、Ⅲ期扩张头皮瓣覆盖植皮区域的方式行美学修复,取得较好的美容效果。结论超长联合皮瓣+自体大张中厚皮游离移植覆盖供皮区是修复与重建大面积头皮缺损伴颅骨外露或缺损的理想方法。

Objective To study the effect of axial scalp flaps transferring with split skin graft for the reconstruction of scalp defect and skull exposure or skull defect. Methods The axial scalp flaps transferring with split skin graft were used to repair 15 cases with scalp defect and skull defect or skull exposure after trauma,electric burns,scar ulcer and tumor or other occasions from May 2004 to March 2014. The maximal scalp defect area was 20 cm×15 cm,the maximal skull exposure area was 16 cm×10 cm,and the maximal skull defect area was 11 cm×7 cm. Results The skin grafting survived more than 95% and the wounds were repaired completely in all 15 cases. During the 1 to 10 years follow-up,all flaps and skin grafts appeared survival without cicatrix hyperplasia. One case with squamous-celled carcinoma of scalp was not found relapse during 5 years follow-up,but one case with recurrent fibroid died of relapse and metastasis of tumor 2 years after the surgery.7 cases were reconstructed by dilator implantation in stage Ⅱ and scalp skin flap covering the donor area in stage Ⅲ. Conclusion The ultralong axial scalp flaps transfer with split skin graft is an effective and preferable choice to repair large scalp defect and skull defect or skull exposure.