电烧伤致头皮巨大缺损合并颅骨外露的皮瓣修复

目的：总结皮瓣修复电烧伤致头皮巨大缺损合并颅骨外露坏死的临床治疗经验，为头部严重电烧伤的治疗提供行之有效的方法。方法：15例电烧伤致头皮巨大缺损创面合并颅骨外露坏死，头皮缺损面积14cm×9cm-21cm×19cm，彻底清除坏死软组织，保留坏死颅骨，利用1～4个局部或带血管蒂的轴型皮瓣修复创面。结果：15例36个皮瓣全部成活，14例一期愈合，1例因缺损面积大，应用4个局部皮瓣修复，张力大，拆线过早，部分裂开，行二次手术修复愈合。其中6例二期行头皮扩张术修复供瓣区游离皮片移植形成的秃发畸形，效果满意。结论：多个局部任意皮瓣或带血管蒂的轴型皮瓣组合是修复头皮巨大面积缺损合并颅骨外露的有效方法，清创时应保留已失活的颅骨以防止颅内感染，并有利于颅骨的修复。

Repair of large area scalp defection and skull exposure after electric burn by skin flap graft

Objective ：To sum up the experience to repair scalp defect and skull exposure after electric burn by skin flap graft and provide effective method for the treatment of serious scalp electric burn. Methods： One or several skin flaps were used to repair 15 cases of large area scalp defect with skull exposure and necrosis after electric burns. The scalp defect area ranged from 14 cm ×9 cm to 21 cm×19 cm. Before skin flap transplantation, all necrosis soft tissues in the wounds were cleaned up completely, and necrosis skull were retained. Results： Thirtysix skin flaps in 15 patients were all survived. Fourteen patients received primary intention healing, and reoperation was performed in the other patient because of disruption of wound. Scalp dilatation was used to treat the baldness anisotrophy in 6 patients. Conclusion ： Combined therapy with several local flaps or axial pattern skin flaps is an effective and convenient method to repair the scalp defect and skull exposure. The necrosis skull should be retained in wound for preventing intracranial infection and repairing skull.