头皮扩张术修复头皮电烧伤颅骨外露创面的方法改进

目的：总结采用头皮扩张术修复头皮电烧伤颅骨外露创面的成功经验。方法：于烧伤后期创面溶痂或剥痂后施术，加强围手术期创面的处理，选择远离创面的垂直小切口，加强创缘与囊腔间的间隔组织，植入1-2个容量200ml的扩张囊，超量注水。结果：2000年3月-2003年1月，治疗5例，8个扩张皮瓣均成活，伤口Ⅰ期愈合，无任何并发症发生，随访显示毛发生长良好。结论：头皮扩张术是修复头皮电烧伤颅骨外露创面的理想方法。     

皮肤扩张术在头皮缺损修复中的应用

目的探讨皮肤软组织扩张术修复头皮软组织缺损的手术方法的改进及并发症防治。方法2002年10月~2005年6月,采用一期置入扩张器行皮肤扩张术,常规注水充分扩张后,二期合理设计扩张皮瓣转移修复缺损的方法,治疗头部皮肤软组织32例。其中男20例,女12例。年龄5~48岁。均为头皮病变手术切除后缺损,缺损范围7cm×5cm~20cm×20cm,均不伴其他部位损伤。置入扩张器均为圆柱形,容积50~250ml,采用注射壶内置法,注水扩张时间6~16周。扩张皮瓣的范围8cm×5cm~25cm×23cm。结果32例头皮缺损均完全修复,仅1例皮瓣远端表皮坏死,经换药治疗后延期愈合,余扩张皮瓣均完全成活。术后随访1年头发生长良好,瘢痕隐蔽,外观满意。并发症4例,分别为皮瓣远端表皮坏死、血肿、扩张器外露和切口裂开各1例。结论皮肤软组织扩张术是一种修复头皮软组织缺损的理想方法。     

超量扩张皮瓣修复大面积皮肤缺损

目的：讨论超量扩张皮瓣用于修复大面积缺损的可行性和风险。方法：24例患者置入83枚扩张器，进行超过额定容积的注水扩张。对注水过程、并发症和术后效果进行分析评价。结果：随扩张器注水增加，皮瓣面积也有增加。扩张皮瓣转移后成尊尚好，效果较满意，但是当超额定容积后并发症有所增多。结论：超量扩张是获得大面积皮瓣的有效方法，但应注意防治并发症。     

头皮扩张术修复瘢痕性秃发

目的：总结头皮扩张术治疗瘢痕性秃发的临床应用经验与教训。方法：回顾1988年1月至2000年12月应用头皮扩张术修复瘢痕性秃发136例。统计秃发面积，扩张容量，修复面积，修复效果，并发症及其原因。结果：本组秃发区大于100cm^2者67例，平均面积103cm^2，共放置容量为140ml-450ml扩张器261个，一次性完全修复秃发者120例，10例经一次头皮接力扩张术或延期再扩张术后完全修复。6例遗留较小面积秃发区。平均4ml扩张容量能修复1cm^2秃发面积。并发症发生率为22％。手术并发症为14．7％，扩张器质量并发症7．3％，影响手术效果的并发症为7．3％。结论：皮肤组织扩张术是修复瘢痕性秃发较理想的方法，平均4ml扩张容量能修复1cm^2秃发面积。提高扩张器质量，重视提高外科基本操作技能可降低头皮扩张术较高并发症的发生率。     

头皮脑回样病变畸形

目的提高对头皮脑回样病变畸形的认识和治疗水平。方法复习有关文献,对头皮脑回样病变畸形的病因、临床表现、诊断、分类和治疗进行了分析,采用切除后植皮或扩张头皮瓣修复治疗6例。结果6例病变切除彻底,随访无复发。其中2例植皮病例患者导致局部秃发,4例扩张头皮瓣修复外形满意。结论头皮脑回样病变畸形是一种罕见的头皮良性病变,头皮扩张术是修复治疗头皮脑回样病变的理想方法。     

应用头皮扩张术治疗头皮缺损颅骨外露

作者应用头皮扩张术修复头皮缺损颅骨外露的创面。Ⅰ期扩张器植入切口可选择在正常头皮上。注水至额定容量。按每修得１ｃｍ２创面需４ｍｌ扩张器容量推算扩张器大小。Ⅱ期皮瓣转移时,去除坏死的颅骨外板,取出扩张器,转移皮瓣。本组５例,共设计８块皮瓣,术后均Ⅰ期愈合。随诊６个月～１年,有毛发生长。作者认为用该方法扩张后皮瓣覆盖颅骨修复头皮缺损,既治疗了疾病又避免了秃发。     

皮肤扩张术用于头皮撕脱回植失败并颅骨裸露的早期修复

目的寻求头皮撕脱回植失败并颅骨裸露较理想的早期修复的方法.方法伤区清创植皮、颅骨裸露区油纱外敷,植皮成活后尽早于创周正常头皮下置入扩张器,注水扩张完成后利用扩张皮瓣修复秃发颅骨裸露区.结果6例除1例出现局部扩张器外露外,均未发生感染、皮瓣坏死等并发症,同时达到创面修复及秃发区重现头发的目的.结论在适当选择适应证及正规操作的前提下,将组织扩张术用于头皮撕脱回植失败并颅骨裸露的早期修复可以取得满意的疗效.     

头皮缺损伴颅骨外露的修复

目的;临床研究应用多种方法修复大面积头皮缺损伴颅骨外露。方法：用皮片移植法、头皮瓣转移加植皮法、远侠皮瓣移植法、多个头皮瓣转移法及头皮扩张Ⅰ期修复头皮缺损伴颅骨外露25例。结果：多个头皮瓣转移法及头皮扩张法取得良好效果,而皮片移植法,远位皮瓣移植法等方法均有不同程度的继发性畸形。结论：为避免继发性畸形的出现,多个头皮瓣转移法及头皮扩张法是修复头皮缺损伴颅骨外露的较好方法。     

皮肤软组织扩张术在头皮缺损伴颅骨外露修复中的应用

目的 探讨外伤致大面积头皮缺损后的肉芽组织创面伴颅骨外露的修复方法.方法 对外伤后头皮缺损肉芽组织创面伴颅骨外露8例患者,在形成新鲜肉芽组织创面后于正常头皮帽状腱膜下埋置皮肤软组织扩张器12只,术中以及注水扩张过程中严格无菌操作,适度扩张,保持扩张部位丰富的血液循环.扩张满意后取出皮肤软组织扩张器行扩张后皮瓣修复创面.结果 8例患者均完成头皮缺损创面的修复,扩张器埋置术后以及注水扩张过程中未见感染.结论 皮肤软组织扩张术可以修复外伤头皮缺损后肉芽组织创面伴颅骨外露.     

颞浅动脉筋膜蒂岛状头皮瓣Ⅰ期修复头皮部分缺损

目前，头皮缺损修复应用较广的仍是头皮扩张术。由于其可提供“额外的”皮肤组织量，对修复较大的创面是一种较理想的手术方法。但其有疗程长、手术次数多、费用高及扩张过程的渗漏、破裂等缺点。各种头皮局部皮瓣描述较多。但局部皮瓣的应用，有时受到血运和修复面积的限制。     

Microsurgical reconstruction of major scalp defects following scalp avulsion

Introduction:

Total scalp avulsion is a serious injury, commonly occurring in Indian females working with industrial and agricultural machines. Their long hairs often get caught in a rapidly revolving machines, resulting in total avulsion of scalp. Lack of education and awareness in Indian villages often result in these patients coming late to the hospitals when replantation is not possible and scalp reconstruction remains the only available option.

Materials and Methods:

We performed our study on 22 cases of scalp avulsion injury presented to us between June 2007 and April 2012 at Department of Burn, Plastic & Reconstructive Surgery, SMS Hospital, Jaipur. In all of them a free tissue transfer was performed as an elective procedure.

Results:

Twenty two patients underwent free tissue transfer and followed up for an average period of 6 months. All patients included in this study were females with mean age of 28 yrs. Five patients in our study reported with partial necrosis of the free flaps which were subsequently managed with split-thickness skin graft (STSG). Two patients reported total necrosis of the flap which was re-operated using latissimus dorsi along with serratus anterior muscle (LDSA) from the contralateral side.

Conclusion:

As scalp avulsion because of rapidly rotating machine leads to large size defect not amenable for local tissue reconstruction. We performed reconstruction using LDSA and omental free flaps with split thickness skin graft (STSG) for large scalp defect and achieved good and stable soft tissue cover with satisfactory cosmesis.KEY WORDS: Latissimus dorsi with serratus anterior flap, scalp avulsion injury, scalp reconstruction     

Erlotinib-induced scalp perifolliculitis

Erlotinib is a highly specific epidermal growth factor receptor tyrosine kinase inhibitor used to treat various metastatic cancers. The most commonly reported side effects in patients receiving erlotinib are dermatitis and diarrhea. The authors present two cases of erlotinib-induced severe scalp perifolliculitis, which is an adverse reaction that has not been reported to date. Both patients developed pustules and thick yellow-green crusted plaques on the scalp within weeks of starting treatment with erlotinib for metastatic non-small cell lung carcinoma. Skin biopsies revealed a perifollicular accumulation of inflammatory cells, lymphocytes, and neutrophils. Both patients were treated with oral doxycycline and achieved complete resolution within 2 to 3 weeks and no recurrence despite continuing the epidermal growth factor receptor tyrosine kinase inhibitor. This is a unique presentation of an erlotinib-induced skin eruption.     

Pilomatrix carcinoma of scalp

Pilomatrixoma was first described in 1880. Since then, approximately 73 carcinomas have been reported in the literature. A 57 year-old man was evaluated for a solitary nodule on the left temporoparietal scalp. Biopsy revealed pilomatrixoma. The lesion was treated by wide surgical resection. The patient was free of disease 6 months after surgery. We report another case of pilomatrix carcinoma arising from the scalp.