额部扩张双蒂轴型皮瓣修复老年患者颅顶部慢性难治性溃疡  

REPAIR OF IMMEDICABLE ULCER IN SKULL CAP WITH EXPANDED BIPEDICAL AXIAL FLAP IN SENILE PATIENTS

作　　者：吴焱秋[1] 柴家科[1] 柳春明[1] 关雪峰[2] 朱志强[3] 孙有志[4] 戴承旺 陈宝驹[1] 

机构地区：[1]解放军总医院第一附属医院烧伤整形外科,北京100037 [2]太钢集团临汾钢铁有限公司职工医院烧伤科 [3]双鸭山矿业集团煤炭总医院烧伤科 [4]辽源矿务局总医院烧伤科 [5]临沂县人民医院外三科

出　　处：《中国修复重建外科杂志》2007年第9期917-920,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨老年患者颅顶部慢性难治性溃疡的治疗方法,及额部扩张双蒂轴型皮瓣的临床应用效果。方法2002年9月~2006年6月,收治5例颅顶部慢性难治性溃疡老年男性患者,年龄55~76岁。外伤1例,感染1例,鳞状细胞癌2例,基底细胞癌1例。病程6~25个月。曾行1~4次手术。溃疡范围5cm×3cm^10cm×9cm。一期手术于颞浅动脉额支下方和额肌下方设计植入皮肤软组织扩张器;二期手术扩大切除颅顶部慢性溃疡,采用额部扩张双蒂轴型皮瓣,旋转移位修复。创面清创后范围为6.0cm×3.5cm^12.0cm×10.5cm,皮瓣切取范围26cm×10cm^34cm×17cm。2例供区利用多余扩张皮瓣修复,3例植皮修复。结果术后皮瓣均成活,伤口期愈合,供区愈合良好。患者均获随访3~24个月,平均10个月。皮瓣附着良好,溃疡无复发,无上睑外翻及眼裂闭合不全,日常生活无不适。结论采用额部扩张双蒂轴型皮瓣修复老年颅顶部慢性难治性溃疡,临床效果满意,是治疗老年患者颅顶部难治性溃疡一种新的手术方法。Objective To investigate the method to repair immedicable ulcer in skull cap in senile patient and the clinical effect of expanded bipedical axial flap in skull cap. Methods From September 2002 to June 2006, 5 patients with immedicable and chronic ulcer in skull cap were treated, All patients were males, aging 55-76 years. Among them, the causes of disease were trauma in 1 case, infection in 1 case, squamous cell carcinoma in 2 cases, and basal cell carcinoma in 1 case. The disease course was 6-25 months, All patients had been treated by 1-4 operations, The area of ulcer ranged from 5 cm × 3 cm to 10 cm × 9 cm. At first stage, soft tissue expander was implanted under the frontal branch of superficial temporal artery and the musculus frontalis according to preoperative design. Then periodic saline injection was carried out after operation. At second stage, the soft tissue expander was taken out, The immedicable ulcer in skull cap was removed, then expanded bipedical axial flap in forehead was designed and transferred to the wound according to the size of the wound. And the donor site was covered with odd expanded flap or split-thickness skin graft. The defect size was 6.0cm×3.5cm to 12.0cm×10.5 cm. The size of the flap was from 26 cm×10 cm to 34 cm×17 cm. Results All the expanded bipedical axial flap survived after operation. The wound had a primary healing. The donor sites healed well. No complications occurred at donor site. All patients were followed up from 3 to 24 months （mean 10 months）. No ulcer recurrence and no incompetence in papebral fissure was found. The patients were satisfied with the operation results. Conclusion The satisfactory clinical results are obtained in repairing immedical ulcer in skull cap in old patients by using expanded bipedical axial flap in skull cap. This operation design can be used as a new method to repair immedical ulcer in skull cap in senile patients.

关 键 词：颅顶部 难治性溃疡 扩张皮瓣 老年 

分 类 号：R632.1[医药卫生—外科学]