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。

APPLICATION OF SKIN SOFT TISSUE EXPANSION TO RECONSTRUCTION OF SCALP SOFT TISSUE DEFECT

OBJECTIVE: To explore an improved method of reconstructing the scalp soft tissue defect with the expanded skin soft tissue and treating and preventing the related complication. METHODS: From October 2002 to June 2005, 32 patients (20 males and 12 females, aged 5-48 years) underwent reconstruction of the scalp soft tissue defects with the expanded scalp soft tissue in the two-stage operation. In the first stage, a tissue expander (cylindrical form, 50-250 ml) was inplanted into the skin to achieve a skin soft tissue expansion. After a sufficient skin expansion (8 cm X 5 cm to 25 cm X 23 cm) was made by the routine water affusion for 6-16 weeks, a properly-designed skin flap was taken and transferred to reconstruct the scalp soft tissue defect in the second-stage of the operation. All the scalp defects were left after the resections of the scalp lesions, which ranged in size from 7 cm x 5 cm to 20 cm x 20 cm. RESULTS: After operation, all the 32 patients had their scalp defects repaired and reconstructed well. The expanded skin flaps of all the 32 patients survived except 1 patient who had a necrosis of the distal epidermis of the flap, which healed after the dressings of the wound. The hair grew well and the scars were hidden with a satisfactory appearance. Four patients developed complications (necrosis of the distal flap in 1 patient, hematoma in 1, expander exposure in 1, and wound rupture in 1). CONCLUSION: Reconstruction of the scalp soft tissue defect with the skin soft tissue expansion is an ideal method.