头皮缺损颅骨外露的修复

我科１９８０～１９９１年收治外伤性或颅面部肿瘤切除后头皮缺损颅骨外露９例，分别应用吻合血管的游离大网膜结合中厚皮片移植、游离皮瓣或轴型皮瓣转位结合皮片移植修复。讨论了修复时机、修复方法以及手术注意事项。认为双侧股前外侧游离皮瓣是修复全头皮缺损颅骨外露的可取方法，而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。     

头皮缺损颅骨外露的修复

我科１９８０－１９９１年收治外伤性或颅面部肿切除后头皮缺损颅骨外露９例，分别应用吻合血管的游离大网膜结合中厚皮片移植，游离皮瓣或轴型皮转位结合皮片移植修复。讨论了修复时机，修复方法以及手术注意事项，认为双侧股前外侧游离皮瓣是修复头皮缺损颅骨外露的可取方法，而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。     

大面积头皮缺损合并颅骨外露或缺损的皮瓣修复

目的 探讨大面积头皮缺损合并颅骨外露或缺损的皮瓣修复方法.方法 对40例大面积头皮缺损合并颅骨外露或缺损患者行双侧旋转皮瓣转移或轴型头皮皮瓣转移结合游离皮片移植修复手术.32例行一期修复,8例行二期修复.结果 所有皮瓣皮片均完全成活.术后随访6个月至2年,未发现头皮坏死,效果满意.结论 双侧旋转皮瓣转移或轴型头皮皮瓣转移结合游离皮片移植是修复大面积头皮缺损合并颅骨外露或缺损的有效方法.     

游离串联皮瓣修复颅骨外露头皮缺损的应用

摘要 目的 探讨合并颅骨外露的大面积头皮缺损的修复方法。方法 应用游离前臂皮瓣及游离股前外侧皮瓣,串联后修复外伤致合并骨外露的头皮缺损7例。将前臂皮瓣血管蒂近端与甲状腺上动脉和颈内静脉吻合,远端与股前外侧皮瓣血管蒂吻合。无骨外露的缺损用游离植皮修复。结果 7例皮瓣存活良好,修复的头皮外观良好,质地柔软。结论 将游离前臂皮瓣和股前外侧皮瓣串联移植,修复大面积头皮缺损临床效果满意。     

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、远位皮瓣移植法、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 2 5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     

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。     

超长联合皮瓣在头皮缺损合并颅骨外露或缺损中的应用

目的探讨运用超长联合皮瓣+自体大张中厚皮游离移植覆盖供皮区修复与重建大面积头皮缺损伴颅骨外露或缺损的效果。方法回顾2004年5月~2014年3月收治的运用超长联合皮瓣+自体大张中厚皮游离移植覆盖供皮区修复与重建大面积头皮缺损伴颅骨外露或缺损的15例患者,均为实施肿瘤扩大切除或清创术后,头皮缺损面积最大为20 cm×15 cm,颅骨外露最大面积16 cm×10cm,颅骨缺损最大面积11 cm×7 cm。结果 15例患者头部缺损均得到良好覆盖,植皮修复创面根据修复创面情况,于术后10~12天拆包,植皮成活率大于95%,残留创面予换药处理愈合。术后随访1~10年,所植皮片质地良好,无明显瘢痕增生。1例头皮鳞状细胞癌患者术后随访5年,复查无肿瘤复发。1例梭形细胞肉瘤患者术后2年肿瘤复发、转移死亡。7例Ⅱ期通过扩张器植入、Ⅲ期扩张头皮瓣覆盖植皮区域的方式行美学修复,取得较好的美容效果。结论超长联合皮瓣+自体大张中厚皮游离移植覆盖供皮区是修复与重建大面积头皮缺损伴颅骨外露或缺损的理想方法。     

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、远位皮瓣移植法、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.     

串联皮瓣修复大面积颅骨外露

目的:研究应用游离皮瓣修复合并颅骨外露的大面积头皮缺损的治疗方法.方法:2005年1月～2011年1月笔者应用串联的前臂皮瓣和股前外侧游离皮瓣,修复合并颅骨外露的大面积头皮缺损6例,采用游离前臂皮瓣近端与甲状腺上动脉和颈内静脉吻合,远端与股前外侧皮瓣血管吻合.两游离皮瓣串联吻合.无骨外露部分游离植皮.结果:6例手术皮瓣均存活良好;植皮愈合良好.头皮外观良好,质地柔软.结论:前臂和股前外侧游离皮瓣串联吻合,修复头皮缺损效果满意.     

头皮缺损合并颅骨外露的皮瓣修复方法探讨

目的:探讨头皮缺损合并颅骨外露的皮瓣修复方法。方法:自2008年1月～2013年3月共收治头皮缺损合并颅骨外露30例,行局部头皮瓣、轴型头皮瓣转移结合皮片移植、上臂带蒂皮瓣修复。头皮缺损最大面积20cm×15cm,颅骨外露最大面积14cm×10cm。结果:共切取皮瓣34块、供瓣区植皮10例。皮瓣皮片均成活良好,术后随访6个月～4年,效果满意。结论:局部头皮旋转皮瓣是修复较小面积(直径小于7cm)头皮缺损优选方法,轴型头皮瓣修复较大面积(直径大于7cm)头皮缺损伴颅骨外露是有效方法,头皮缺损合并面部皮肤缺损行同侧上臂带蒂皮瓣修复也是较理想的方法。     

游离股前外侧皮瓣在复杂头皮软组织缺损中的应用

目的 探讨游离股前外侧皮瓣修复复杂头皮软组织缺损的临床疗效。方法 应用游离股前外侧皮瓣修复20例复杂头皮软组织缺损患者,其中合并颅骨外露6例,颅骨缺损3例,合并感染4例,合并头皮疤痕挛缩9例。头皮缺损面积6 cm×10 cm～22 cm×13 cm,颅骨外露6 cm×8 cm～21 cm×12 cm。结果 术后随访6个月～2年,19例皮瓣均完全成活,皮瓣柔软,无明显色素沉着。其中1例小儿患者术后第3天出现皮瓣远端颅顶部部分发黑,予以换药、温盐水热敷、蒂部缝线拆除后皮瓣成活,但遗留色素沉着。20例患者中,仅1例发生供区发生植皮边缘坏死,予以换药处理后创面愈合。结论 旋股外侧动脉降支与颞浅动脉口径相当,应用游离股前外侧皮瓣可有效修复创伤及肿瘤所致复杂头皮软组织缺损。     

游离皮瓣在颅骨外露的头皮缺损中的应用

目的:报告应用游离皮瓣修复头皮缺损致颅骨外露的方法和临床疗效。方法:本组5例患者年龄5～58岁,平均35岁,因创伤、肿瘤等原因造成头皮部分缺损并颅骨外露,缺损面积在8cm×10cm～15cm×10cm;缺损部位为颞部、顶部及额部。分别选用游离胸脐皮瓣、旋股外侧皮瓣和胫后动脉皮瓣等移植修复创面。结果:本组5例患者移植皮瓣Ⅰ期成活,其中2例移植皮瓣后行头皮扩张术,术后扩张头皮全部覆盖创面,毛发生长良好。术后随访6～18个月,患者皮瓣除臃肿外,创面Ⅰ期愈合,外形效果好。结论:采用吻合血管的游离皮瓣移植修复颅骨缺损,可以在短期内完全覆盖裸露的颅骨,确保了颅骨的成活。皮瓣成活后,可以Ⅱ期手术修整或头皮扩张术,既修复创面又能恢复头部外观,是一种理想的修复方式。     

Scalp reconstruction by microvascular free tissue transfer

We report on a series of patients with scalp defects who have been treated with a variety of free flaps, spanning the era of microvascular free tissue transfer from its incipient stages to the present. Between 1971 and 1987, 18 patients underwent scalp reconstruction with 21 free flaps: 11 latissimus dorsi, 3 scalp transfers between identical twins, 3 groin, one combined latissimus dorsi and serratus anterior, two serratus anterior, and one omentum. These flaps were used to cover scalp defects resulting from burns, trauma, radiation, and tumors in patients ranging from 7 to 79 years of age. Follow-up has ranged from 3 weeks to 7 years. All of our flaps survived and covered complex defects, many of which had failed more conservative attempts at cover. One patient received radiation therapy to his flap without unfavorable sequelae. This experience began with a pioneering omental flap and includes cutaneous and muscle flaps. The latissimus dorsi is our first choice for free flap reconstruction of extensive, complicated scalp wounds because of its large size, predictable blood supply, ease of harvesting, and provision of excellent vascularity to compromised beds.     

Reconstruction of large defects in the scalp with fasciocutaneous flaps.

Although recent reports have emphasised free microsurgical transfer for reconstruction of extensive defects in the scalp, in our experience a carefully planned scalp flap is a simpler and safer method than a free transfer. Twenty-one patients with defects as large as 10%-60% of the scalp surface area were reconstructed; the calvarium was resected in five cases and the dura mater in two. In 18 cases the flaps were based on a single pedicle: the superficial temporal artery. In three cases the blood supply of the flaps was based on three major homolateral arteries: the superficial temporal, the posterior auricular, and the occipital. The blood supply of all scalp flaps was based on the interconnected network of the aponeurotic plexus and the pedicles were included into flap in 18 cases. The principles of fasciocutaneous flaps were applied for all 21 scalp flaps. The reconstruction of the skull was delayed in all cases, and the dura was replaced by free autogenous periosteum. The donor area was covered with a skin graft in all cases. In all patients the aesthetic and functional results were considered excellent by them and by us. There were no postoperative complications.     

Free latissimus dorsi flap transfer for subtotal scalp and cranium defect reconstruction: report of 7 cases

OBJECT: The purpose of the paper is to review the results of free latissimus dorsi transfer for scalp and cranium reconstruction in case of large defects with exposed brain tissue, deperiosted cranial bone, and dura that cannot be reconstructed with local flaps or skin grafts. METHODS: Free latissimus dorsi transfer was carried out in an interdisciplinary approach involving neurosurgery and plastic surgery in seven patients with subtotal and total scalp defects (two reconstruction after tumor removal, two reconstructions after longstanding osteitis, 2x tissue break down after irradiation, 1x defect reconstruction after high voltage injury). There were three male and four female patients. The age ranged from 36 to 72 years. Reconstruction was carried out with a muscle flap (1x) or a myo-cutaneous flap (6x) in combination with a split thickness skin mesh (1:1.5) graft, done in a single-stage procedure. In a retrospective clinical study the following criteria were evaluated: 1) flap healing, 2) esthetic result, and 3) complications. All flaps healed primarily, and all wound remained closed without any signs of infection. Complete wound healing was achieved after 4-8 weeks, depending on the healing of the skin grafts. Secondary skin grafting was necessary in two patients, revision of the donor site in two patients. From an esthetic point of view four patients complained about the appearance of the retroauricular skin island. After removal of the skin island 6 months after the initial operation, all patient judged the result as good or acceptable. CONCLUSION: Besides the free omentum flap, the free latissimus dorsi transfer is the only option for coverage of subtotal or total scalp defects. Compared to the omentum flap, the latissimus dorsi offers more tissue, has less donor site morbidity, and secondary surgery such as cranial bone reconstruction is possible. Contrary to most authors, our preferred donor vessels are maxillary artery and the external jugular vein. To avoid any vascular compression we are using a myo-cutaneous flap. The skin island must be removed secondarily. In patients were no bone reconstruction is possible or planned, the deepithelialized skin paddle can be used for correction of a contour defect.     

Free latissimus dorsi flap transfer for subtotal scalp and cranium defect reconstruction: report of seven cases

The purpose of this paper is to review the results of free latissimus dorsi transfer for scalp and cranial reconstruction in the case of large defects with exposed brain tissue, cranial bone without periosteal cover, and dura, which cannot be reconstructed with local flaps or skin grafts. Free latissimus dorsi transfer was carried out in seven patients with subtotal and total scalp defects (two reconstruction after tumor removal, two reconstructions after long-standing osteitis, two tissue breakdown after irradiation, one defect reconstruction after high voltage injury). There were three male and four female patients. The age ranged from 36 to 72 years. Reconstruction was performed with a muscle flap (1) or a myocutaneous flap (6) in combination with a split-thickness skin mesh (1:1.5) graft in a single-stage procedure. In a retrospective clinical study, the following criteria were evaluated: (1) flap healing, (2) aesthetic result, and (3) complications. All flaps healed primarily, and all wounds remained closed without any signs of infection. Complete wound healing was achieved after 4 to 8 weeks, depending on the “take” of the skin grafts. Secondary skin grafting was necessary in two patients, while revision of the donor site was necessary in two patients. From an aesthetic point of view, four patients complained about the appearance of the retroauricular skin island. After removal of the skin island 6 months after the initial operation, all patients judged the result as good or acceptable. Besides the free omentum flap, the free latissimus dorsi transfer is the only option for cover of subtotal or total scalp defects. Compared to the omentum flap, the latissimus dorsi offers more tissue, has less donor site morbidity, and secondary surgery such as cranial bone reconstruction is possible. Contrary to most authors, our preferred donor vessels are maxillary artery and the external jugular vein. To avoid any vascular compression, we use a myocutaneous flap. The skin island must be removed secondarily. In patients where no bone reconstruction is possible or planned, the de-epithelialized skin paddle can be used for correction of a contour defect.This work was presented at the Spring Meeting of the Belgian Society for Plastic, Reconstructive and Aesthetic Surgery, May 8, 2004 in Ghent, Belgium.     

Closure of craniofacial defects after cancer resection

Resection of malignancies of the upper face and skull base may result in complex bone and soft tissue defects. To better define the optimal management of these defects, we conducted a retrospective review of 75 consecutive patients who underwent closure of 76 craniofacial defects after malignant tumor excision from 1966 to 1990. Wound complications requiring further surgery occurred in 30% of the defects (23 of 76). Wound complications at anterior, temporal, or combined sites were correlated with each method of reconstruction (scalp flap or split thickness skin graft, pedicled myocutaneous flap, and free flap). The presence of a large combined defect involving both frontal and temporal areas was the only significant risk factor for development of a wound complication requiring secondary surgery. These data suggest that anterior or temporal craniofacial defects may be closed with either scalp flaps and split thickness skin grafts or pedicled myocutaneous flaps with reasonable wound complication rates of 16% to 22%. Large combined defects have high wound complication rates (90%) when local tissue is used; therefore, other methods of closure such as free tissue transfer should be strongly considered in these patients.     

Management of chronic osteomyelitis of the skull using vascularized omental transfer

A case of chronic osteomyelitis of the skull with a large scalp and bony defect is presented. Following radical debridement, a vascularized flap of omentum was used for coverage, in conjunction with antibiotics administered intravenously. Some basic considerations in the management of osteomyelitis are discussed, as are the advantages of omentum as a material for scalp replacement.