Kwon Ho, Kim Hyung-Jun, Yim Young-Min, Jung Sung-No
Department of Plastic Surgery, Uijongbu St Mary's Hospital, College of Medicine, Catholic University of Korea, Uijongbu, Korea.
J Craniofac Surg. 2008 Jul;19(4):1075-9. doi: 10.1097/SCS.0b013e31817bd820.
Scalp necrosis is an infrequent complication of Moyamoya disease surgery, which is more prevalent in the parietotemporal area. Because scalp vascularity is severely compromised after Moyamoya disease surgery, reconstruction of defects with local scalp tissue is challenging. To cover defects, a flap is needed that is highly vascularized and has great mobility and territory to avoid existing scars. After tracing ipsilateral occipital artery, an advancement flap that was based on occipital artery and vein was designed to fit the defect. The flap was elevated in the subperiosteal layer and advanced without tension to cover the defect. Occipital pedicle V-Y advancement flaps were used in 7 patients who had scalp necrosis of the parietotemporal area and a mean defect size of 8.7 cm. There were no complications such as flap necrosis, infection, or recurrence of defect in all patients during 9-month follow-up. Occipital pedicle V-Y advancement flap is a useful alternative flap for scalp defects after surgical treatments that compromise scalp vascularity, such as Moyamoya disease surgery.
头皮坏死是烟雾病手术中一种罕见的并发症，在顶颞区更为常见。由于烟雾病手术后头皮血管严重受损，用局部头皮组织修复缺损具有挑战性。为了覆盖缺损，需要一个血管丰富、活动度大且面积大的皮瓣，以避开现有的瘢痕。在追踪同侧枕动脉后，设计了一个以枕动脉和静脉为蒂的推进皮瓣来修复缺损。该皮瓣在骨膜下层掀起，无张力推进以覆盖缺损。枕动脉蒂V-Y推进皮瓣应用于7例顶颞区头皮坏死且平均缺损面积为8.7 cm的患者。在9个月的随访中，所有患者均未出现皮瓣坏死、感染或缺损复发等并发症。枕动脉蒂V-Y推进皮瓣是烟雾病手术等损害头皮血管的手术治疗后修复头皮缺损的一种有用的替代皮瓣。
