颅骨修补术后钛板外露原因及皮瓣修复经验

Cause of titanium plate exposure after cranioplasty and the experience in skin flap repair

目的总结皮瓣修复治疗颅骨修补后钛板外露的原因及皮瓣修复的经验。方法回顾2016年1月—2020年12月该院采用自体皮瓣修复治疗钛板外露患者共11例,记录并分析钛板外露的时间、原因、类型、皮瓣治疗方式及治疗效果。结果经皮瓣修复后,10例愈合良好,1例因皮瓣中心区真皮层萎缩塌陷,术后4个月时再次出现钛板外露,予钛板部分取出并全厚皮片移植后痊愈。结论头皮真皮层损伤或缺失是钛板外露的重要原因,自体皮瓣修复治疗颅骨修补术后钛板外露具有一定临床疗效,可帮助部分患者免于直接钛板取出。

Objective To investigate the cause of titanium plate exposure after cranioplasty and the experience in skin flap repair.Methods A retrospective analysis was performed for the clinical data of 11 patients who received autologous skin flap repair and experienced titanium plate exposure in our hospital from January 2016 to December 2020,including the time,cause,and type of titanium plate exposure,treatment modality of skin flap repair,and treatment outcome.Results The interval from decompression to repair ranged from 2 months to 2 years for the 11 patients,the interval from repair to titanium plate exposure ranged from 1 month to 15 years,and the interval from titanium plate exposure or infection to attending the hospital ranged from 6 days to more than 1 year.According to the location of wound,10 patients had frontotemporal wound,and 1 had occipital wound.As for the type of wound,7 patients had poor healing of incision scar,2 had poor healing of the central area of titanium plate,1 had loosening after titanium plate repair,and 1 had skin lesion caused by trauma.After skin flap repair,10 patients achieved good clinical healing,and 1 had atrophy and collapse of the dermis at the central area of skin flap,experienced titanium plate exposure again at 4 months after surgery,and was cured after removal of partial titanium plate and full thickness skin grafting.Conclusions Damage or loss of the dermis of the scalp is an important reason for titanium plate exposure and is an important part for reconstruction in skin flap repair.Autologous skin flap repair has a certain clinical effect in the treatment of titanium plate exposure after cranioplasty,and individualized regimens should be selected based on the degree of dermis loss,the blood supply of different defect sites and adjacent scalp skin,and the degree of scalp activity.Clinical results show that this method can help to avoid the direct removal of titanium plate in some patients.