头皮缺损伴颅骨外露创面的组织瓣修复策略  

Tissue flap repair strategy for scalp defects with exposed skull wounds

作　　者：李罡 张志 孙敬恩 林伟华 李孝建 Li Gang;Zhang Zhi;Sun Jing'en;Lin Weihua;Li Xiaojian(Department of Burns and Plastic Surgery,Guangzhou Red Cross Hospital,Jinan University,Guangzhou 510220,China)

机构地区：[1]暨南大学附属广州红十字会医院烧伤整形科,广州510220

出　　处：《中华烧伤与创面修复杂志》2024年第9期828-834,共7页Chinese Journal of Burns And Wounds

基　　金：广州地区特色临床技术项目(2023C-TS46);广州市科技计划(202102010046)。

摘　　要：目的探讨头皮缺损伴颅骨外露创面的组织瓣修复策略。方法该研究为回顾性观察性研究。2019年1月—2023年12月,暨南大学附属广州红十字会医院收治18例符合入选标准的不同头皮缺损伴颅骨外露创面面积(以下简称头皮缺损面积)的患者,其中男13例、女5例,年龄17~59岁。清创后,头皮缺损面积为1 cm×1 cm~25 cm×25 cm。针对头皮缺损面积<9 cm 2且周围头皮局部条件较好的患者,采用局部皮瓣(面积为2 cm×2 cm~5 cm×5 cm)进行创面修复;将皮瓣供区创面拉拢缝合,若缝合张力较大则取头部皮片进行创面修复。对于头皮缺损面积>9 cm 2且≤1/4头皮总面积的患者,采用扩张皮瓣(面积为5 cm×3 cm~12 cm×12 cm)进行创面修复;将皮瓣供区创面直接拉拢缝合。对于头皮缺损面积>1/4头皮总面积且≤1/2头皮总面积的患者,采用游离股前外侧皮瓣(面积为9 cm×7 cm~29 cm×14 cm)进行创面修复;将皮瓣供区创面分层缝合,若张力较大则移植同侧大腿皮片进行修复。对于头皮缺损面积>1/2头皮总面积的患者,采用游离大网膜瓣(面积为28 cm×23 cm~29 cm×26 cm)+大腿皮片进行创面修复,并直接缝合切取大网膜瓣造成的腹部切口。记录术中移植的组织瓣类型。术后,观察组织瓣及受区移植皮片成活情况、皮瓣供区创面/切取大网膜瓣造成的腹部切口愈合情况。随访时,观察组织瓣成活情况、皮瓣供区创面/切取大网膜瓣造成的腹部切口瘢痕增生情况。末次随访时,复查头部CT评估颅骨有无坏死。结果针对本组病例头皮缺损伴颅骨外露创面,4例患者采用局部皮瓣修复,其中2例患者采用局部V-Y推进皮瓣修复,2例患者采用局部双蒂拱顶石皮瓣修复,术后皮瓣均完全成活。5例患者采用扩张皮瓣修复,其中1例患者埋置2个皮肤软组织扩张器,4例患者埋置1个皮肤软组织扩张器,术后扩张皮瓣均完全成活。7例患者采用游离股前外侧皮瓣Objective To investigate the strategy of using tissue flaps for repairing scalp defects with exposed skull wounds.Methods This study was a retrospective observational study.From January 2019 to December 2023,18 patients(13 males and 5 females,aged 17-59 years)with different scalp defect combined with skull exposure area(hereafter referred to as scalp defect area)who met the inclusion criteria were admitted to Guangzhou Red Cross Hospital of Jinan University.After debridement,the scalp defect area was 1 cm×1 cm to 25 cm×25 cm.For patients with scalp defect area<9 cm 2 and good local conditions of the surrounding scalp,local flaps with area of 2 cm×2 cm-5 cm×5 cm were used for wound repair.The wound in the donor site of the flap was pulled together and sutured.If the suture tension was large,the skin graft from the head was taken and transplanted for wound repair.For patients with scalp defect area>9 cm 2 and≤1/4 of the total scalp area,expanded flaps with area of 5 cm×3 cm-12 cm×12 cm were used for wound repair.The wound in the donor site of the flap was pulled together and sutured directly.For patients with scalp defect area>1/4 and≤1/2 of the total scalp area,free transplantation of anterolateral thigh flaps with area of 9 cm×7 cm-29 cm×14 cm were used for wound repair.The wound in the donor site of the flap was sutured in layers,and the skin graft from the ipsilateral thigh was transplanted for repair if the tension was large.For patients with scalp defect area>1/2 of the total scalp area,free greater omental flap(28 cm×23 cm-29 cm×26 cm in area)transplantation and thigh skin graft were used for wound repair.The abdominal incision caused by cutting the greater omental flap was sutured directly.The types of tissue flaps were recorded during operation.After operation,the survival of tissue flaps and skin graft in the recipient sites was observed,and the wound healing of flap donor sites/abdominal incision caused by cutting the greater omental flap was observed.During follow up,the survival of tissue

关 键 词：外科皮瓣 伤口愈合 头皮缺损 颅骨外露 

分 类 号：R641[医药卫生—外科学]