显微外科技术修复全头皮撕脱伤的临床应用

Clinical application of microsurgical technique in the repair of total scalp avulsion

目的总结应用显微外科技术修复全头皮撕脱伤的相关临床经验。方法回顾性分析自2009年9月至2016年10月,空军军医大学第一附属医院整形外科收治的6例全头皮撕脱伤患者的临床资料。患者均为女性,缺血时间12~16 h,平均13.8 h。4例为全头皮回植,1例部分回植+部分反取回植,1例全头皮回植+面颊部软组织反取回植。其中4例吻合血管数为1条动脉和1条静脉,1例为2条动脉和1条静脉,1例为2条动脉和2条静脉,均未行血管桥接。结果回植皮瓣成活面积:3例>90%,2例约60%,1例皮瓣完全坏死后采用背阔肌肌皮瓣游离移植+刃厚皮片移植修复残余创面。瘢痕性秃发患者采用皮肤扩张术修复,回植成活后的头皮外观及感觉功能恢复良好。结论采用显微外科技术对撕脱头皮进行回植可以达到理想的功能和美学修复效果,充分的术前评估、术中彻底清创、精确判断血管损伤程度、熟练的血管吻合技术及术后护理是全头皮撕脱显微修复成功的关键,结合后期皮肤扩张术可获得较理想的修复效果。

Objective To summarize the clinical experience of microsurgical technique in the repair of total scalp avulsion.Methods Medical records of 6 patients who suffered total scalp avulsion from September 2009 to October 2016 were reviewed retrospectively.All patients were female.The ischemic time was from 12 to 16 hours,with the average of 13.8 hours.In 4 patients,total scalp replantation was performed.In 1 patient,partial replantation was performed.In 1 patient,total scalp replantation and buccal soft tissue replantation were performed.The number of anastomosis vessels was one artery and one vein in 4 patients,two arteries and one veins in 1 patient and two arteries and two veins in 1 patient.No bridging vascular was performed.Results The survival area of replanted flap was more than 90%in 3 patients and more than 60%in 2 patients.The complete necrosis in 1 patient was treated by free latissimus dorsi myocutaneous flap and split-thickness skin graft.Patients with cicatricial alopecia were repaired by skin expansion.The appearance and sensation of scalp recovered well after replantation.Conclusion The ideal function and aesthetic effect can be achieved by scalp replantation by microsurgical technique.Adequate preoperative evaluation,thorough debridement during the operation,accurate judgment of the degree of vascular injury,skilled vascular anastomosis technology and postoperative care were the key to success.Combined with later skin expansion,the ideal efficacy can be obtained.