游离肩胛皮瓣移植修复头皮大面积缺损合并骨外露  

Free scapular flaps become a choice for repairing large-area scalp defect and skull exposure

作　　者：鲍世威[1] 马小兵[1] 赵红艺[1] 钱文江[1] 杨明勇 

机构地区：[1]卫计委北京医院整形外科,北京市100730 [2]中国医学科学院整形外科医院,北京市100041

出　　处：《中国组织工程研究》2014年第51期8315-8319,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:游离肩胛皮瓣具有可提供面积大、皮瓣色泽好、质地优良、薄厚适中、皮瓣易于切取、血管恒定、供区隐蔽等特点,适合作为大面积头皮缺损伴有骨外露的首选皮瓣之一。目的:回顾性分数应用肩胛皮瓣游离移植修复复杂的大面积头皮缺损合并颅骨外露的方法及经验。方法:对8例头皮大面积缺损合并颅骨外露患者,采用切取游离肩胛皮瓣,将旋肩胛动静脉与颞浅动静脉或面动静脉吻合方法修复大面积缺损及骨外露。随访6-12个月,观察游离肩胛皮瓣移植后皮瓣感染情况,游离肩胛皮瓣成活情况,供皮区处理及愈合结果及不良反应。结果与结论:全部8例肩胛皮瓣均一期成活,2例出现静脉回流不畅,给予针刺放血及拆除远端部分缝线后好转;术后随访期间,皮瓣血运良好,头部局部外形好,未见并发症。结果提示游离肩胛皮瓣血管恒定,血运可靠,皮瓣色泽质地优良,可切取面积大,对供区影响小,可作为修复大面积头皮缺损的选择方法之一。BACKGROUND： The local flap and expanded flap cannot repair the large area scalp defect, especially for patients with skull exposure and infection. The free flap is suitable for this kind of cases. The free scapular flap shows many advantages： constant vessel site, stable blood supply, supporting the amount and variability of tissue types available for harvest and minor deformity of the donor site. It is one of the most excellent choices for large-area scalp defects and skull exposure. OBJECTIVE： To retrospectively analyze the method and experience of repair!ng the large area scalp defect and skull exposure by free scapular flaps. METHODS： Free scapular flaps were used to repair the large-area scalp defects and skull exposure in eight patients. The circumflex scapular vessel was anastomosed with superficial temporal vessel or facial vessel. The patients were followed up for 6-12 months to observe the postoperative conditions of free scapular flaps, such as infection, flap survival, donor site treatment, wound healing and adverse reactions. RESULTS AND CONCLUSION： All the free scapular flaps survived well in eight cases. The venous stagnation of flap happened in two cases. After punching the flap or removing the suture in the distal end of flapsl the blood supply was improved. During the 1-year follow-up, the blood supply of free scapular flaps and the shape of head were satisfactory. There was no postoperative complication. These findings indicate that the free scaPular flap characterized as constant vessel site, stable blood supply, supporting the amount and variability of tissue types available for harvest and minor deformity of the donor site is one of the most excellent choices for repair of large area scalp defects and skull exposure.

关 键 词：肩 外科皮瓣 移植物 头皮 组织构建 组织工程 肩胛皮瓣 头皮缺损 游离移植 骨外露 皮瓣 

分 类 号：R318[医药卫生—生物医学工程]