保留坏死颅骨外板与皮瓣修复烧伤颅骨坏死创面的观察

Clinical observation of preservation of necrotic skull external plate combined with skin flap in the repair of electrical burn wounds of the head

目的探讨保留坏死颅骨外板联合皮瓣转移修复电烧伤致颅骨坏死创面的可行性方法及其疗效。方法在全身麻醉下清除变性坏死头皮、帽状腱膜及骨膜,保留变性坏死颅骨外板,对已碳化的外板予以凿除,并保留板障及内板,采用皮瓣覆盖创面。术后观察皮瓣静脉危象情况,监测重要脏器功能及颅内压变化。二期行软组织扩张术修复供瓣区秃发畸形。结果本组共10例男性患者。其中8例行一期封闭颅骨外露创面的皮瓣全部成活,无坏死、感染等并发症发生;1例患者因皮瓣拉拢缝合时张力较大,且拆线过早致局部切口裂开、颅骨再次外露而行坏死颅骨外板凿孔,形成肉芽组织后植皮愈合;1例因颅骨全层坏死,术中将坏死外板部分凿除,给予皮瓣覆盖创面6个月后,影像学检查示颅骨缺损。结论选择性保留颅骨坏死外板,可有效改善术后患者头部的外观形态,降低后期修复难度与治疗费用。

Objective To explore the feasibility and efficacy of preservation of the necrotic skull external plate combined with skin flap in the repair of electrical burn wounds. Methods From 2002 to 2013, 10 patients with necrotic exposed skull caused by electrical burns were treated. Under general anesthesia, the degenerative and necrotic scalp, galea aponeurotica, and periosteum were removed.The degenerative and necrotic skull external plate was retained, while the carbonized external plate was removed, and the board and inner plate were retained. The wound surface was covered with a skin flap. The venous crisis of the flap was observed and the changes in important organ function and intracranial pressure were monitored after the operation. Soft tissue expansion was conducted to repair the alopecia deformity of the donor site at stage II. Results In this study, all recruited patients were males. In eight patients, all flaps to cover the skull exposed wounds had survived at stage I. No complications such as necrosis or infections occurred. Local incision dehiscence occurred in one patient because of great tension in the flap closure and suture. In another patient, a skull defect was observed through an imaging examination at 6 months after operation. Conclusion Selective preservation of the necrotic skull external plate can effectively improve the appearance of the head in patients with injuries caused by electrical burns. This procedure can reduce the difficulty of later repair and treatment cost.