头皮撕脱伤患者的诊治流程

Protocol of diagnosis and treatment for scalp avulsion injury

目的通过回顾和分析临床资料，总结及评价头皮撕脱伤患者的诊治流程。方法收治的26例头皮撕脱伤患者中，全头皮撕脱15例（包括5例超全头皮），部分头皮撕脱11例，其中16例伴发颅骨外露，2例伴发失血性休克。急诊时的一期治疗措施为：吻合血管回植术11例，头皮修薄回植术9例，颅骨钻孔＋二期植皮术4例，游离皮瓣修复术1例，局部皮瓣转移术1例。根据不同治疗方法更换术式、术后创面的二次处理、术后效果，以及各种不同的临床情况总结出最优化的处理手段。针对不同程度头皮撕脱伤的临床资料，参考有关文献资料及治疗经验，提出头皮撕脱伤的诊治流程。结果吻合血管回植后的成活头皮形态和功能恢复最佳，毛发恢复生长，术中发现血运不良的病例，改行头皮修薄回植。针对14种不同的临床表现及术中情况，提出了10种相应的处理方法。结论在处理头皮撕脱伤时，应根据伤情按诊治流程做出最优化的选择。

Objective To search for a treatment approach for scalp avulsion injury based on the clinical experiences and review of literature. Methods Twenty-six consecutive scalp avulsiort cases were involved in the study： 15 cases were complete scalp avulsion （5 including forehead skin） and 11 cases were partial scalp avulsion. Cranial bones exposure occurred in 16 cases, 11 of which had a size over 4×4 cm^2. The treatment methods were various： 11 cases with microsurgical replantation, 9 cases with skin grafting, 4 cases with secondary skin grafting followed by multiple drilling of the calvarium, 1 case with local flap, and 1 case with free flap. According to the clinical cases and literature reviews, authors tried to search for an optimal protocol. Results Patients with microsurgical replantation achieved the best recovery including hair growth. In case of not qualified or fail to microsurgical replantation, skin graft could be considered as an aherative step, whereas the result of it was no hair growth and usually scar healing. In summary, 14 different clinical conditions followed with 10 surgical techniques were concluded in a route chart. Conclusions To achieve the optimal outcomes of scalp avulsion injury, proper techniques should be chosen according to the treatment protocols.