双侧旋转皮瓣一期修复头皮巨大肿物切除后继发创面

目的：为头皮巨大肿物切除后形成的近似圆形缺损，寻求一种较简便安全、损伤小的一期修复方法。方法：在直径5～10cm的头皮缺损区周围，选择、设计双侧旋转皮瓣，剥离后将皮瓣旋转移位修复创面，供区拉拢缝合。自1996年6月～2006年10月共修复58例。结果：术后皮瓣全部成活，伤口均I期愈合。其中49例获随访1～6年，病变无复发，修复区头发生长良好，瘢痕不显露。结论：双侧旋转皮瓣一期修复中等大小的头皮缺损，可充分利用邻近的头皮组织，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。     

舌形皮瓣修复头皮缺损的临床应用

头皮肿瘤、瘢痕等切除术后形成的缺损常近似为圆形,修复的最佳方法是利用邻近的正常头皮组织行局部皮瓣转移,以达到既治疗疾病又避免秃发的目的。自1998年6月至2003年12月,笔者对39例不同病因形成的头皮缺损患者应用单侧或双侧反向舌形皮瓣行即刻修复,均取得了良好的效果。现报     

舌形皮瓣修复头皮缺损的临床应用

头皮肿瘤、瘢痕等切除术后形成的缺损常近似为圆形，修复的最佳方法是利用邻近的正常头皮组织行局部皮瓣转移，以达到既治疗疾病又避免秃发的目的。自1998年6月至2003年12月，笔者对39例不同病因形成的头皮缺损患者应用单侧或双侧反向舌形皮瓣行即刻修复，均取得了良好的效果。现报道如下。     

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。     

头皮缺损修复方法的选择

目的 探讨头皮缺损修复方法的选择。方法 2007年6月至2014年6月,共收治头皮缺损36例,其中外伤16例,肿瘤术后20例。分别应用直接缝合或局部皮瓣(28例),筋膜瓣联合植皮(4例),远位皮瓣(2例),游离皮瓣(2例)修复创面。结果 术后随访1~6个月,全部头皮创面应用皮瓣(植皮)修复均存活,无明显术后并发症。与其他方法相比,采用直接缝合或局部皮瓣修复的患者术后瘢痕不明显,毛发生长良好。结论 应用局部皮瓣修复较大(直径<10 cm)头皮创面,手术操作简便,皮瓣易存活,术后毛发生长良好,是治疗头皮缺损较理想的方法。     

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。     

头皮扩张皮瓣移植分期修复跨发际的头面部大面积缺损

目的 总结应用头皮扩张皮瓣移植分期修复跨发际的头面部大面积缺损的经验和策略.方法 跨发际的头面部组织缺损5例,包括烧伤后头面部瘢痕并秃发3例、色素痣2例,采用皮肤扩张皮瓣移植分二期或三期修复.二期手术共2例,Ⅰ期于头部植入扩张器,同时施行脐旁皮瓣或肩胛皮瓣游离移植修复面部缺损;Ⅱ期行扩张头皮转移修复秃发区.三期手术3例,Ⅰ期于头部和肩背部同时植入扩张器,Ⅱ期行扩张头皮转移,Ⅲ期行预扩张颈浅血管蒂肩背皮瓣岛状转移修复面部.结果 5例皮瓣均全部成活.术后随访6～36个月,秃发区95％以上得到覆盖,面部外观良好. 结论 跨发际的头面部大面积缺损需修复头部秃发区和面部,应用头皮扩张术和皮瓣移植术的分期修复方法能获得良好的外观并缩短治疗周期.     

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。     

双叶旋转皮瓣在修复头皮缺损中的应用

目的：探讨和评价应用双叶旋转皮瓣修复头皮缺损的临床效果。方法：手术于局麻下进行,距头皮皮损边缘0.2cm～0.5cm完整切除皮损后,在缺损区周边正常头皮设计双叶旋转皮瓣,修复创面。结果：本组20例,缺损区域面积最大5cm×2.7cm,最小2cm×1.5cm,术后伤口均Ⅰ期愈合,皮瓣颜色、质地与周围头皮基本一致,术后随访1～12个月,皮瓣区毛发生长状况与周围头皮一致,切口瘢痕不明显,无感觉异常。结论：应用双叶旋转皮瓣修复头皮缺损,皮瓣张力小、血运丰富、易于成活,且毛发生长正常,皮瓣与周边头皮衔接良好,达到整形美容效果,是解决中小面积头皮缺损修复的一种良好方法,值得推广应用。     

易位筋膜皮瓣修复儿童腹股沟区瘢痕挛缩畸形

目的　介绍股前内侧易位筋膜皮瓣修复儿童腹股沟区烧伤愈合后瘢痕挛缩畸形。方法　 1989年8月～ 1999年 8月 ,收治 33例腹股沟区瘢痕挛缩病人 ,年龄 3～ 11岁。手术在股前内侧设计一个由大的舌形主皮瓣和蒂在对侧的三角皮瓣 ,缺损缘与主皮瓣的夹角三部分组成的易位筋膜皮瓣修复腹股沟区缺损 ,切取皮瓣最大为18cm× 10 cm,最小为 13cm× 8cm,易位夹角 6 0°～ 80°,主皮瓣修复腹股沟缺损区 ,三角形皮瓣修复供瓣区 ,手术一期完成。结果　 33例 5 1个移位皮瓣均成活 ,术后下肢、会阴部功能及外观满意。结论　股前内侧易位筋膜皮瓣适用于儿童腹股沟烧伤瘢痕挛缩畸形的修复 ,且不需植皮修复供瓣区     

Reconstruction of large alopecia with old technique: V‐Y‐S plasty

Treatment of alopecia following burns, trauma or tumour surgery is challenging. Local flaps for small or medium sized defects and tissue expansion for larger defects is the common approach. Tissue expansion is a two‐stage procedure and the inflation process causes difficulty for patients. V‐Y‐S plasty is safe and one‐stage method of tissue reconstruction for scalp, face and other parts of the body. We performed this method safely for very large alopecia reconstructions in the scalp.     

Surgical treatment of secondary cicatricial alopecia of scalp and eyebrow

Secondary cicatricial alopecia occurs as a result of destruction of hair follicles by scar tissue formed in the scalp and eyebrows. It is a permanent condition and regrowth of hairs in the area is not expected. The purpose of the study was to select the appropriate method for treating cicatricial alopecia. 24 patients were admitted to our hospital during the period from June 2006 to July 2007. They were suffering from acquired cicatricial alopecia affecting the scalp and the eyebrow. Their ages ranged from 6-48 years with mean age 26-25 years. They were treated surgically by total excision of the lesions with direct closure of the defect in ten cases, excision of alopecia with advancement flaps with the aid of scalp expanders in seven cases, scalp reduction through serial excision of alopecia in three cases and excision of alopecia and reconstruction of the defect by strip composite hair-bearing scalp grafts in four cases. Our results suggest there are three key factors that decide the surgical methods for treating alopecia: size, location and shape. We also discuss and evaluate the various techniques of reconstruction. Good results were obtained in 18 patients.     

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.     

单侧或两侧反向舌形皮瓣修复创面

目的　对体表肿瘤、慢性溃疡和瘢痕挛缩等切除后,以及外伤造成的软组织缺损,寻求一种较简便安全、效果确切的即刻修复方法。方法　1993年8 月～1997 年10 月,依据创面的部位及大小,在其邻近设计并制作单侧或两侧反向舌形皮瓣,修复头面、四肢及肩部近似圆形的创面31例,供瓣区多数可直接缝合。结果　术后伤口均Ⅰ期愈合,皮瓣全部成活,创面修复平整,瘢痕不明显,外形及功能良好。结论　舌形皮瓣具有血供丰富,成活率高,应用灵活,随意性强,操作简便,创伤较小,可充分利用邻近的组织等优点。     

308-nm Excimer Laser for the Treatment of Alopecia Areata

BACKGROUND Alopecia areata is loss of hair from localized or diffuse areas of hair-bearing area of the skin. Recently there are reports of efficacy of the 308-nm excimer radiation for this condition.
OBJECTIVE To study the effect of the 308-nm excimer laser in the treatment of alopecia areata.
MATERIALS AND METHODS Eighteen patients with 42 recalcitrant patches (including 1 adult with alopecia totalis) were enrolled in this study. The lesions were treated with the 308-nm excimer laser twice a week for a period of 12 weeks; one lesion on each patient was left as a control for comparison.
RESULTS There were 7 males and 11 females in this study. Regrowth of hair was observed in 17 (41.5%) patches. Thirteen of the 18 lesions in scalp showed a complete regrowth of hair. The extremity regions failed to show a response. Atopic diatheses had an unfavorable effect on the outcome in our patients.
CONCLUSION The 308-nm excimer laser is an effective therapeutic option for patchy alopecia areata of the scalp and for some cases with patchy alopecia areata of the beard area. It does not work for patchy alopecia areata of the extremities.     

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.     

Reconstruction of Scalp Defects Using Simple Designed Bilobed Flap

We have devised a novel rational method to design a bilobed flap. In our method, two triangle flaps are designed; the angle of the first flap is three-fourths the angle of a rhombus at the defect site, and the angle of the second flap is also three-fourths that of the first flap. We have successfully performed reconstruction of scalp defects as large as 50 × 45 mm using simple designed bilobed flaps. The location of the defect was the parietal region in 10 cases, the frontal region in 6 cases, the temporal region in 3 cases, and the occipital region in one case. The advantages of this method for use in reconstruction of scalp defects are as follows: (1) the dispersion tension on the flap provides stable circulation and prevents expansion of scar formation; (2) since the suture line is zigzag, alopecia at the suture line can be hidden under the hair; (3) since this flap is a random pattern flap using galea aponeurotica with blood flow to the skin, flap design is possible for any part of the scalp; and (4) design and elevation of this flap are easy and do not take much time.     

A-T形皮瓣修复头皮缺损

目的：介绍头皮缺损修复的一种方法。方法：先将缺损修剪成梯形或等腰锐角三角形创面。沿底边向两侧做切口线,长度分别为底边边长的1～2倍;切口线末端各做一个顶与创面方向相反,边长为1～1．5cm的等腰三角形,以利于皮瓣向创面移动。在帽状腱膜层与颅骨骨膜之间形成皮瓣,向受区推进修复创面。结果：14例头皮缺损中,面积最小为3cm×3cm,最大为6cmc4cm,全部皮瓣存活良好,创面得以Ⅰ期修复。结论：A-T形皮瓣制作简单,因该皮瓣的剥离范围广泛,对于皮肤缺乏弹性和活动性的头部来讲,是修复该部位缺损的一种良好方法。