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。

Clinical application and the effect inquiry of tissue expansion for reconstruction of cicatricial alopecia

Objective To investigate the experiences in clinical application of scalp expansion technique for treatment of cicatricial alopecia, and to emphasize the importance of scalp flap design. Methods From January 1991 to December 2002, 148 cases with cicatricial alopecia were treated by scalp expansion technique. 272 soft tissue expanders with volume sizes from 100~500ml were used. After scalp expansion, 141 cases were only repaired by transposition of random pattern scalp flap, 3 cases with temple defect and 2 cases with hairline defect were repaired by transposition of the combination of random pattern scalp flap and superficial temporal vessel island scalp flap, and 2 cases with hair island in the cicatricial alopecia were repaired by making full use of hair island in the scar and forming superficial temporal vessel island scalp flap. Results In this group of patients, 135 cases were completely repaired after one expanding operation. Among these cases, typical case with 12cmX14cm cicatricial alopecia was completely repaired after one expanding operation, and satisfactory effect was obtained in this case. 8 cases were repaired after re-expanding operation. 5 cases were incompletely repaired after treatment. The complication incidence rate was about 17.6%. Conclusion Scalp expansion technique has a good effect for the treatment of large cicatricial alopecia and it is the best choice for reconstruction of large cicatricial alopecia. After scalp expansion, combined uses of random pattern scalp flap and superficial temporal vessel island scalp flap have a certain value of clinical application and indication. An ideal scalp flap design might enhance repairing effects.