Hussussian Christopher J, Reece Gregory P
Division of Plastic Surgery, Washington University, St. Louis, MO, USA.
Plast Reconstr Surg. 2002 May;109(6):1828-34. doi: 10.1097/00006534-200205000-00008.
The literature regarding reconstruction of large scalp wounds with free tissue transfer consists mostly of case reports and small series, and none of the published reports focus on the particular problems of the oncology patient. Here the authors describe their experience with 37 flaps in 32 patients, all of whom required scalp reconstruction with free tissue transfer after tumor extirpation. Twenty-seven free flaps were performed at the time of the initial surgery and 10 were performed after a prior reconstruction failed. The authors describe the characteristics of the patients and procedures, including tumor type, wound size and complexity, flaps and recipient vessels used, preoperative and postoperative radiation therapy, and complications. Most (72 percent) of the tumors were recurrent or persistent. The free tissue transfer was successful in all patients. There was a 59 percent overall complication rate with 32 percent of patients requiring a secondary surgical procedure. Most of the complications were wound-healing complications. Although there were two cases of vein thrombosis, these were salvaged by revision, and no flaps were lost. Nine patients underwent postoperative radiation therapy that was well tolerated. Only four patients underwent cranioplasty at the time of the initial operation, and no secondary cranial reconstructions were performed. The authors conclude that preoperative and postoperative radiation therapies as well as the need for expedient tumor resection and immediate flap coverage are issues that make free tissue transfer attractive for the oncology patient who needs scalp reconstruction. Although the complication rate is relatively high and a significant percentage of patients require a secondary procedure, free flap coverage was efficacious for all patients in this group. Cranioplasty is not usually required but, if needed, alloplastic or autologous cranial reconstruction does not appreciably increase morbidity in the selected patient.
关于采用游离组织移植修复大面积头皮伤口的文献大多为病例报告和小样本系列研究，且已发表的报告均未关注肿瘤患者的特殊问题。在此，作者描述了他们对32例患者实施37例皮瓣移植的经验，所有这些患者在肿瘤切除后均需采用游离组织移植进行头皮重建。27例游离皮瓣移植在初次手术时进行，10例在先前的重建失败后进行。作者描述了患者的特征和手术过程，包括肿瘤类型、伤口大小和复杂性、所使用的皮瓣和受区血管、术前和术后放疗以及并发症。大多数（72%）肿瘤为复发性或持续性肿瘤。游离组织移植在所有患者中均获成功。总体并发症发生率为59%，32%的患者需要二次手术。大多数并发症为伤口愈合相关并发症。虽然有2例发生静脉血栓形成，但通过翻修得以挽救，未出现皮瓣丢失情况。9例患者术后接受放疗，耐受性良好。初次手术时仅4例患者进行了颅骨成形术，未进行二次颅骨重建。作者得出结论，术前和术后放疗以及快速切除肿瘤和即刻皮瓣覆盖的需求，使得游离组织移植对需要头皮重建的肿瘤患者具有吸引力。尽管并发症发生率相对较高，且相当比例的患者需要二次手术，但游离皮瓣覆盖对该组所有患者均有效。通常不需要颅骨成形术，但如有需要，在选定患者中，异体或自体颅骨重建并不会明显增加发病率。
