大面积头皮缺损合并颅骨外露的创面修复体会  

Wound Repair Experience in the Treatment of Extensive Scalp Defect Complicated with Skull Exposure

作　　者：李菊芳[1] 金杰波[1] 何庆[1] 

机构地区：[1]玉溪市人民医院普外科,云南玉溪653100

出　　处：《中国烧伤创疡杂志》2016年第2期104-109,共6页The Chinese Journal of Burns Wounds & Surface Ulcers

摘　　要：目的探索一次性手术修复大面积头皮缺损合并颅骨外露的理想方法。方法回顾性总结分析云南省玉溪市人民医院2007-2014年收治的23例不同原因导致的头皮缺损伴颅骨外露经手术治疗的患者资料,术中分别采取自体皮片移植术、板障层植皮术、头皮扩张器置入术、邻位双蒂推移皮瓣移植术等方法修复创面。感染创面、残余创面均采用皮肤原位再生医疗技术治疗,对比观察不同治疗方法的创面愈合效果。结果23例患者的头部创面均修复良好,术后随访1~8年,创面愈合良好,无复发,无明显瘢痕增生。采用邻位双蒂推移皮瓣修复创面的效果优于其他方法。结论邻位双蒂推移皮瓣修复不同面积的皮肤缺损、颅骨外露、颅骨坏死等创面均具有良好的治疗效果,且手术操作简便,手术时间较短,皮瓣成活率较高,通常无需二次手术即能达到良好的修复效果。此外,皮肤原位再生医疗技术也是治疗感染创面、残余创面的有效方法。Objective To explore an ideal treatment for the one-time surgical repair of extensive scalp defects complicated with skull exposure.Methods Retrospectively review the medical records of 23 patients with extensive scalp defects and skull exposure resulted from different causes,who were admitted into Yuxi People＇ s Hospital between 2007 and2014 and underwent surgical treatments.During the surgical treatments,autologous skin flap grafting,skin grafting on the diploic layer,scalp expander implantation,Ortho bipedicle flap shift transplanting were applied to repair wounds.Infected wounds and residual wounds were all treated with the skin in situ regenerative medical technology.Healing effects of wounds treated with different methods were observed and compared.Results The scalp wounds of 23 patients restored well,and the post-operational follow-up for 1- 8 years showed the defect wounds healed well,without relapse or obvious scar hyperplasia.The repair effects of the ortho bipedicle flap shift transplanting were superior to that of other methods.Conclusion The ortho bipedicle flap shift transplanting can realize excellent therapeutic effects when applied in the repair of skin defect of different sizes,skull exposure,skull necrosis and etc.It is easy to operate,needs less operation time and has higher survival rate of skin flaps,by which excellent repair effects can be achieved with no need of a second operation generally.Moreover,the skin in situ regenerative medical technology is an effective method of treating infected wounds and residual wounds.

关 键 词：头皮缺损 颅骨外露 双蒂皮瓣 植皮 皮肤原位再生医疗技术 

分 类 号：R622[医药卫生—整形外科]