扩张头皮瓣结合毛囊移植治疗大面积瘢痕秃发术后美学效果观察

Clinical observation of expanded scalp flap combined with hair follicle transplantation to improve the aesthetic appearance of large area cicatricial alopecia

目的 探讨合理地设计头皮瓣结合皮瓣边缘微小区域毛发移植改善扩张头皮转移治疗瘢痕秃发的美学效果。方法 2018年7月至2021年10月,空军军医大学西京医院整形外科应用头皮扩张术修复瘢痕性秃发患者18(男14,女4)例,平均年龄26.3岁。所有患者根据秃发面积、部位和邻近区域毛发生长情况选择扩张器大小和数量,在秃发区周边正常毛发区行一期扩张器置入手术,定期注水达到满意扩张效果。二期手术切除瘢痕秃发区头皮组织,合理设计扩张头皮局部推进、易位旋转皮瓣,修复瘢痕切除后的创面。18例患者均在扩张皮瓣覆盖后的边缘及发际线区等微小区域实施了毛囊移植。结果 扩张头皮瓣主要并发症2例(11.1%)、次要并发症1例(5.5%)。扩张皮瓣重建配合毛囊移植后随访观察,扩张皮瓣成活良好,毛发分布均匀,密度适中,扩张头皮边缘线状瘢痕不明显,发际线区毛发生长方向自然。结论 采用扩张头皮瓣可修复大面积瘢痕秃发,结合毛囊移植可改善修复后美学细节。

Objective To explore the effect of reasonable design of rotating scalp flap combined with hair transplantation on the edge of skin flap to improve the aesthetic appearance of expanded scalp transfer in the treatment of cicatricial alopecia.Methods From July 2018 to October 2021,a total of 18 patients(14 males and 4 females)with cicatricial alopecia were repaired with scalp expander in Department of Plastic Surgery,Xijing Hospital,Air Force Medical University,with an average age of 26.3 years.After the original wound was covered and healed,the appropriate size and number of dilators were selected according to the baldness area,location and hair growth in the adjacent area,and the primary dilator was implanted in the normal hair area around the alopecia.Regular water injection was implemented to achieve satisfactory expansion.The scalp tissue in the cicatricial alopecia was removed by two-stage operation,and local advance and transposition rotation flap were reasonably designed to repair the wound after scar resection.Hair follicle transplantation was performed in all 18 patients in small areas such as the flap edge and hairline area after flap transposition.Results There were 2 major(11.1%)and 1 secondary(5.5%)complications.Follow-up observation after reconstruction of expanded scalp flap combined with hair follicle transplantation showed that the expanded scalp flap survived well,the hair distribution was uniform,the hair density was good,the linear scar at the edge of the expanded scalp was not obvious,and the hair growth direction in the hairline was natural.Conclusion The use of expanded scalp flap combined with marginal hair follicle transplantation can improve the aesthetic details after the repairment of large area cicatricial alopecia.