全头皮撕脱伤的显微外科治疗  

Microsurgical treatments of total scalp avulsion

作　　者：张婷 韩夫 刘佳琦 闫鹏 胡大海 韩军涛 郑朝 Zhang Ting;Han Fu;Liu Jiaqi;Yan Peng;Hu Dahai;Han Juntao;Zheng Zhao(Department of Burns and Cutaneous Surgery,the First Affiliated Hospital of the Air Force Medical University,Xi’an 710032,China)

机构地区：[1]空军军医大学第一附属医院烧伤与皮肤外科,西安710032

出　　处：《中华整形外科杂志》2020年第6期650-654,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨全头皮撕脱伤的显微外科治疗方法和临床效果。方法2013年12月至2019年11月,空军军医大学第一附属医院烧伤与皮肤外科共收治全头皮撕脱伤患者4例,年龄31~56岁,均为女性,全头皮撕脱伤并伴有不同程度颅骨外露,均通过显微外科方法进行修复。1例于伤后24 h行吻合血管的头皮原位再植。2例无再植条件并颅骨外露,行游离背阔肌肌瓣覆盖颅骨外露创面,生物敷料覆盖肌瓣及其他创面,二期切取自体中厚皮片移植修复创面。1例为伤后外院行头皮原位缝合后全头皮坏死入院,经腹腔镜下切除大网膜,行吻合血管的大网膜移植,生物敷料覆盖大网膜表面,二期自体皮片移植修复创面。观察患者术后情况。结果所有病例术后随访2个月至3年,头皮原位再植的1例患者术后头皮成活满意,头发再生良好,瘢痕不明显。背阔肌肌瓣移植复合自体皮片移植的2例患者头部外观较为臃肿,肌瓣移植部位遗留瘢痕秃发且供瓣区损伤大。大网膜移植复合自体皮片移植的1例患者头部外观饱满光滑,质地柔软,腹部供区损伤小且无明显腹部并发症,但术后遗留全头皮瘢痕秃发。结论通过显微外科技术吻合血管的头皮原位再植仍是全头皮撕脱伤创面修复的最佳选择,对于不能进行头皮原位再植并大范围颅骨外露的创面修复,游离背阔肌肌瓣移植、腹腔镜切除大网膜游离移植复合自体皮片移植,亦可获得良好的临床效果。Objective To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods From December 2013 to November 2019,four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery,the First Affiliated Hospital of the Air Force Medical University.All cases were female,aged 31-56 years old and with varying degrees of cranial exposure,and were treated through microsurgery for scalp repair and reconstruction.1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury.2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound,and biological dressing for covering the latissimus dorsi flap and other scalp defect wound.After that,the wound was repaired with intermediate split thickness skin grafting in second stage operation.1 patient,who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit,was treated with microsurgical transplantation of laparoscopically harvested free omentum,and covered the omentum with biological dressings,combined with second stage skin grafting.Results All cases were followed up for 2 months to 3 years.1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival,good hair regeneration and no obvious scar formation.After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases,the head was relatively bloated,with scarred scalp and hair loss,as well as high donor site morbidity.The case,who received free omentum transplantation combined with autologous skin grafting,was plump and smooth in head appearance and soft in texture.There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions In situ replantation with microsurgical anastomosis is the best choice of

关 键 词：显微外科 再植术 网膜 头皮撕脱伤 

分 类 号：R641[医药卫生—外科学]