婴儿先天性头皮全层缺损的修复

目的 探讨婴儿先天性头皮全层缺损的修复方法.方法 1996至2008年,对6例先天性头皮伞层缺损的患儿采用换药、皮瓣转移、扩张器扩张二期颅骨修补术等方法进行治疗.结果 6例头顶创面全部愈合.5例术后随访3个月至1年,2例有部分斑秃,2例瘢痕不明显.1例失访.结论 对缺损较小的头顶创面可换药愈合;对中等创面可用皮瓣修复;对巨大全层缺损创面先行换药,同时埋置扩张器扩张,二期行颅骨修补加扩张皮瓣转移术.     

Purse-string closure of scalp defects following tissue expansion: an effective aesthetic alternative.

Primary closure of scalp defects under tension can be complicated by scar widening and alopecia, and large defects usually require the use of local flaps, skin grafts or free flaps. Tissue expansion facilitates the use of local flaps to cover large defects, but multiple expanders and complex flaps with extensive incisions may cause significant scars and alopecia. We describe a purse-string closure of expanded scalp tissue following excision of a large congenital nevus sebaceous. This scalp reconstructive technique minimises iatrogenic scars and uses the predictable forces of scar contracture and skin re-draping to achieve a superior aesthetic result.     

Tissue expansion in the treatment of alopecia

During the period December, 1983 to August, 1984, 14 patients were treated for alopecia of the scalp using tissue expansion in the Northern Ireland Plastic and Maxillo-Facial Service. Nine of the defects were due to burns. Representative case reports are presented and the planning of advancement and rotation flaps described. The management and prevention of complications are discussed, and the conclusion drawn that tissue expansion is a valuable technique in the treatment of alopecia, allowing reconstruction of defects previously beyond adequate surgical repair.     

THE USE OF TISSUE EXPANDERS IN SCALP ALOPECIA

This paper examines the role of tissue expansion, to correct scalp alopecia. The technique provides a means of producing sufficient hair bearing scalp to close defects which were previously not correctable. Reference is made to several surgical techniques which were found to be useful.     

Aesthetic Reconstruction of Burn Alopecia by Using Expanded Hair-Bearing Scalp Flaps

Tissue expansion is one of the most important armamentaria for aesthetic scalp reconstruction after burn; however, the proper way to employ this technique for the scalp reconstruction usually presents a challenge to the plastic surgeon, especially in the case of a ``sideburn' scenario or a large lesion, as with, for example, hemiscalp alopecia. In this article, 11 patients, with different degrees of hair-bearing scalp loss as a result of burn, and including four patients with hemiscalp alopecia were successfully treated by using tissue expansion. The results show that tissue expansion is a simple, safe, and efficient technique for aesthetic scalp reconstruction. Versatile design of the expanded scalp flap can distribute the expanded hair-bearing scalp properly in the reconstructed recipient site.     

Applications and complications of tissue expansion in pediatric patients

We have reviewed our experience with 61 tissue expansions in 49 pediatric patients. Indications for expansion included traumatic alopecia or soft tissue loss, myelomeningocele, congenital hairy nevi, burn scars, and other less common defects. The complication rate, necessitating interruption of expansion, was 25%. This occurred more frequently with scalp and burn reconstruction. Nevertheless, 86% of patients ultimately achieved good to excellent results.     

Treatment of cicatricial alopecia by the method of tissue expansion

The tissue extension method was applied in 13 patients with cicatricial alopecia of the scalp. Eighteen Soviet-made tissue expanders were used. Clinical experience showed that the sequelae of burns of the scalp attended by alopecia should be treated by tissue extension. The growth of hair can be restored on up to half of the scalp surface by expansion of the local tissues by their direct transfer and by additional formation of grafts for contour plastics. Plastics by expanded tissues is indicated for closure of naked bones of the vault of the skull.     

Planning of a local flap of expanded scalp for repair of alopecia cicatrisata

Tissue expansion of scalp opens a new way for the treatment of alopecia cicatrisata. From May 1986 to April 1988, 56 cases of alopecia cicatrisata and skull outcrop had been repaired by Chinese tissue expander in our department. All cases got good results. Of them, the area of alopecia was over 120 cm2 and the greatest one (320 cm2) consisting of two third of the total scalp in 21 cases. There were 49 cases repaired by one expansion and other 7 cases followed by a secondary expansion. The characteristics of the expanded scalp and the common types of local flap design had been discussed. It was applicable for all kinds of alopecia cicatrisata and both for children (over 3 yrs) and adults. The results of scalp expansion in children revealed superior than that in adults. We considered that the repairing of alopecia cicatrisata by scalp expansion had more advantages than other methods.     

组织扩张术在瘢痕性秃发修复中的应用及疗效探讨

目的:探讨头皮扩张术治疗瘢痕性秃发的临床应用经验,强调头皮瓣设计的重要性。方法:1991年1月至2002年12月,应用头皮扩张术治疗瘢痕性秃发148例,手术选用100～500ml扩张器272个。头皮经扩张后采用如下方式进行修复:①单纯采用常规任意头皮瓣修复秃发区139例;②结合运用Orticochea多瓣法修复2例;③结合采用颞浅血管岛状头皮瓣转移修复鬓角3例、发际2例;④选择性将瘢痕性秃发区中存留的正常岛状生发头皮,形成以颞浅血管为蒂的岛状头皮瓣转移修复2例。结果:本组病例,修复秃发最大面积为310cm2,其中一典型病例,秃发面积达12cm×14cm,经一次扩张后修复全部秃发区。本组148例,一次性完全修复秃发135例,2例经接力扩张、6例经延期扩张后完全修复,剩余5例未完全修复,并发症发生率为17.6%。结论:头皮扩张术治疗大面积瘢痕性秃发有良好的整复效果,是大面积瘢痕性秃发较为理想的治疗方法。头皮扩张术结合多种类型头皮瓣设计的灵活运用可提高并改善瘢痕性秃发的修复效果。     

扩张术治疗瘢痕性秃发的手术设计

目的:探讨头部扩张器修复瘢痕性秃发手术设计的重要性.方法:采用AutoCAD软件测量秃发面积,用一个或多个扩张器进行头皮扩张,利用扩张皮瓣修复瘢痕性秃发.结果:修复瘢痕性秃发18例,扩张皮瓣全部成活,头皮瓣毛发分布均匀,随访半年～1年,效果满意.结论:该方法的手术设计,是手术成败的关键,扩张术修复瘢痕性秃发并发症发生率低,毛发分布均匀,是目前治疗此类疾病的首选方法,值得推广.     

多只扩张器超量扩张修复大面积瘢痕性秃发

目的 探讨应用多只扩张器超量扩张头皮修复大面积瘢痕性秃发的临床效果.方法 Ⅰ期手术：根据秃发区的形状、面积大小,选择多只扩张器,在肿胀麻醉下,置于头部有发区帽状腱膜下,注射壶外置.超量扩张3～6个月,以获得额外有发头皮.Ⅱ期手术：将扩张器取出,切除瘢痕,将扩张后的有发头皮,采用滑行推进皮瓣、旋转皮瓣与易位皮瓣联合运用的手术方式,修复头皮秃发区.结果 23例患者术后秃发区修复效果良好,外观满意.结论 多只扩张器超量扩张可获得大量额外扩张头皮.合理设计皮瓣转移术,最大限度地提高了扩张皮肤的利用率,可修复大面积瘢痕性秃发,修复效果良好.     

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。     

Supragaleal placement of tissue expander for post-burn alopecia.

Supragaleal placement of tissue expander for management of alopecia of scalp excludes tough galeal layer so that easier and faster expansion of scalp may be achieved.     

皮肤软组织扩张术修复大面积瘢痕性秃发

目的探讨皮肤软组织扩张术修复大面积瘢痕性秃发的临床应用。方法1989年1月～2003年12月,应用皮肤软组织扩张术,扩张有头发的头皮组织,切除秃发区瘢痕,用推进或旋转方式修复瘢痕性秃发38例,秃发瘢痕范围15cm×7cm～23cm×15cm。结果全部患者均能消除秃发瘢痕,术后随访1～2年,头发生长良好。结论组织扩张术是修复大面积瘢痕性秃发的主要方法之一。     

Pretransfer tissue expansion of a scalp free flap for burn alopecia reconstruction in a child: a case report

A nine-year-old boy who sustained severe grease-fire burns over his right scalp, face, neck, and trunk 14 months previously, presented with extensive alopecia over the right frontotemporoparietal scalp. Near complete coverage of the scalp defect was obtained with pretransfer expansion of the left temporoparietal scalp, followed by free-flap transfer of the expanded tissue to the defect. Pretransfer tissue expansion has the advantages of increasing flap surface area and minimizing donor site deformity. This case illustrates the applicability of pretransfer tissue expansion of free flaps, and demonstrates the excellent results achievable with free-flap scalp transfers.     

Scalp expansion in the treatment of cicatricial alopecia

The experiences of scalp expansion in the treatment of scarred alopecia in 16 cases with 21 tissue expanders are presented. In 13 cases, the defects were over 90cm2 in area, the largest one extending over half of the total hair-bearing scalp. In all cases, apart from one, the expanding procedures were completed. In one case the procedures were partially completed because of extrusion of the expander. Follow-up of 13 cases for 6-24 months showed good hair growth and appearances and 2 cases had 1.2-1.5 cm of widened scar at the distal edge of the expanded scalp due to undue tension. The advantages, disadvantages and complications are discussed.     

Scalp expansion flaps

A mean 5 year review of 20 patients who had surgery for localised alopecia of the scalp is presented. The technique of using scalp expansion flaps is described and evaluated: it is associated with a low morbidity and high patient satisfaction rate; it provides an excellent one-stage procedure for intermediate size defects and, in the frontal area, for larger defects. Particular emphasis is laid on making incision lines at right angles to the direction of hair growth in order to cover stretched scars, and in performing Z-plasties when closing small scalp defects. Finally, a rationale for the treatment of localised areas of baldness according to their size is put forward.     

多个扩张器联合扩张修复大面积头皮瘢痕性秃发

目的:探讨多个扩张器联合扩张修复大面积头皮瘢痕性秃发的效果。方法:2003年5月~2013年5月间,应用2~4个扩张器联合扩张的方法修复缺损面积为50~350cm2的头皮瘢痕性秃。手术分两期:Ⅰ期根据秃发面积的大小及部位,选择适当大小、形状及数量的扩张器,并在瘢痕周围置入扩张器注水扩张;Ⅱ期根据瘢痕切除术后的缺损情况进行滑行推进或旋转皮瓣修复。结果:80例头皮瘢痕性秃发,74例取得良好效果;3例秃发面积过大,一次扩张未能完全修复,经二次扩张修复后效果良好;1例出现切口感染而取出扩张器;2例出现Ⅱ期术后头皮血肿,经处理后愈合良好。随访5个月~5年,头皮头发生长良好,缝线处无明显瘢痕增生,头部外观有明显改善,患者对手术效果均比较满意。结论:应用多个扩张器联合扩张修复大面积头皮瘢痕性秃发,可以彻底切除瘢痕,使秃发部位有毛发覆盖,头部整体外观得到明显改善,是修复大面积瘢痕性秃发较为理想的一种方法。     

应用双侧舌形皮瓣即刻修复头皮缺损

目的:为头皮肿瘤、瘢痕等切除后形成的近似圆形的头皮缺损,寻求一种较简便安全、损伤小、无秃发的即刻修复方法。方法:在直径4～6cm的头皮缺损区周围,选择、设计双侧反向舌形皮瓣,剥离后将皮瓣旋转移位修复创面,供区拉拢缝合。自1998年6月至2004年6月共修复21例。结果:术后皮瓣全部成活,仅1例有一侧皮瓣尖端表皮坏死,其余伤口均I期愈合。其中19例获随访1～6年,局部病变无复发,修复区平整,头发生长良好,瘢痕不显露。结论:双侧舌形皮瓣即刻修复中等大小的头皮缺损,可充分利用邻近的头皮组织,具有设计灵活,操作简单,创伤相对较小,术后不遗留秃发,瘢痕不显露等优点。但缺损直径大于6cm或形状不规则者不宜应用。     

Aesthetic Results of Treatment of Large Alopecia with Total Scalp Expansion

In the last 7 years, 18 patients with large alopecia (approximately one-third of hair-bearing scalp) were treated with 31 tissue expansion procedures. In the previous 44 patients, with various degrees of alopecia treated with conventional tissue expansion technique, the major complication rates were as high as reported in the relevant literature. The clinical experience gained with these cases led us to make some modifications in the surgical technique. We applied some simple surgical maneuvers and Z-plasties to the last 18 cases with large alopecia. The major complication rate of 3.2% observed in this study is comparable to the lower complication rates of 6–12% reported in the literature for different degrees of alopecia. We believe that these simple modifications and meticulous approach improve the results of conventional treatment of alopecia with tissue expansion and flap. In this paper, details of the insertion technique and reconstructive procedures and their relevance to the success rate of the aesthetic treatment of the large alopecia are discussed.