Lipa Joan E, Butler Charles E
Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 443, Houston, TX 77030-4009, USA.
Head Neck. 2004 Jan;26(1):46-53. doi: 10.1002/hed.10338.
Reconstruction of scalp and calvarial defects after tumor ablation frequently requires prosthetic cranioplasty and cutaneous coverage. Furthermore, patients often have advanced disease and receive perioperative radiotherapy. We evaluated the complications of scalp reconstruction with a free latissimus dorsi muscle flap in this setting.
The complications and the oncologic and aesthetic outcomes of six consecutive scalp reconstructions with a free latissimus dorsi muscle flap and skin graft in five patients with advanced cancer were retrospectively evaluated. Patient, tumor, defect, reconstructive, and other treatment characteristics were reviewed. Reconstructive and perioperative techniques intended to improve flap survival and aesthetic outcome and reduce complications in these patients.
All patients (52-76 years old) had recurrent tumors (sarcoma, melanoma, or squamous cell carcinoma) and received postoperative radiotherapy. The mean scalp defect size was 367 cm(2), and partial-thickness or full-thickness calvarial resection was required in all six cases. No vein grafts were needed. The mean follow-up period and disease-free survival time were 18 and 13 months, respectively. Three patients died of their disease, and two survived disease free. There were no flap failures or dehiscences. Complications consisted of donor site seroma in two patients; partial skin graft loss in one patient; and radiation burns to the flap, face, and ears in one patient. Scalp contour and aesthetic outcome were very good in all cases except for the one case with radiation burns.
Good outcomes were achieved using a free latissimus dorsi muscle flap with a skin graft for flap reconstruction in elderly patients with advanced recurrent cancers who received perioperative radiotherapy. Several technical aspects of the reconstruction technique intended to enhance the functional and aesthetic outcome and/or reduce complications were believed to have contributed to the good results.
肿瘤切除术后头皮和颅骨缺损的重建通常需要进行颅骨成形修复和皮肤覆盖。此外，患者往往患有晚期疾病并接受围手术期放疗。我们评估了在这种情况下使用背阔肌游离肌皮瓣进行头皮重建的并发症。
回顾性评估了5例晚期癌症患者连续6次使用背阔肌游离肌皮瓣和皮肤移植进行头皮重建的并发症、肿瘤学及美学效果。对患者、肿瘤、缺损、重建及其他治疗特征进行了回顾。采用重建和围手术期技术以提高皮瓣存活率、改善美学效果并减少这些患者的并发症。
所有患者（年龄52 - 76岁）均患有复发性肿瘤（肉瘤、黑色素瘤或鳞状细胞癌）并接受了术后放疗。头皮缺损平均面积为367平方厘米，所有6例均需进行颅骨部分厚度或全层切除。无需静脉移植。平均随访期和无病生存期分别为18个月和13个月。3例患者死于疾病，2例无病存活。未发生皮瓣坏死或裂开。并发症包括2例供区血清肿；1例部分皮肤移植失败；1例皮瓣、面部和耳部发生放射性烧伤。除1例发生放射性烧伤的病例外，所有病例的头皮轮廓和美学效果均良好。
对于接受围手术期放疗的晚期复发性癌症老年患者，使用背阔肌游离肌皮瓣联合皮肤移植进行皮瓣重建取得了良好效果。重建技术的几个技术方面旨在提高功能和美学效果及/或减少并发症，被认为对取得良好结果起到了作用。
