Karsidag Semra, Ozcan Arzu, Ozkaya Ozay, Ugurlu Kemal, Bas Lütfü
Plastic, Reconstructive and Aesthetic Surgery Clinic, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
J Craniofac Surg. 2009 Nov;20(6):2248-51. doi: 10.1097/SCS.0b013e3181bf871b.
Pericranial flap is a composite flap involving the periosteum of the skull with its overlying loose areolar tissue termed subgaleal fascia. The multiple blood supply of the pericranial tissue enables this versatility, with a rich, anastomosing arterial supply from the supraorbital, supratrochlear, superficial temporal, posterior auricular, and occipital vessels. Thus, the shape, size, and location of the pericranial flap could be altered as long as a sufficient pedicle width could be fashioned to maintain a blood supply. In our study, we have performed wide bipedicled pericranial flap in scalp reconstruction in 2 cases. After tumor excision was completed, a pericranial flap was planned on the caudal side of the defect. A bipedicle-based pericranial flap was outlined with the use of a sharp dissection; this flap was elevated in a submusculoaponeurotic plane. The bipedicled pericranial flap, whose arterial supply was from the superficial and posterior auricular arteries, was transposed to the frontal defect.We preferred a bipedicled flap, whose arterial supply is from the superficial temporal and posterior auricular arteries to augment vascular supply. If a large, long pericranial flap is required, making the flap pedicled ensures stable blood supply.
颅骨膜瓣是一种复合组织瓣，包含颅骨骨膜及其上方的疏松结缔组织，即帽状腱膜下筋膜。颅骨膜组织的多源性血供使其具有这种多功能性，其丰富的吻合动脉血供来自眶上动脉、滑车上动脉、颞浅动脉、耳后动脉和枕动脉。因此，只要能形成足够宽的蒂以维持血供，颅骨膜瓣的形状、大小和位置都可以改变。在我们的研究中，我们对2例头皮重建患者实施了宽双蒂颅骨膜瓣手术。肿瘤切除完成后，在缺损的尾侧设计颅骨膜瓣。使用锐性分离法勾勒出双蒂颅骨膜瓣；该瓣在肌肉腱膜下平面掀起。动脉血供来自颞浅动脉和耳后动脉的双蒂颅骨膜瓣被转移至额部缺损处。我们更倾向于选择动脉血供来自颞浅动脉和耳后动脉的双蒂瓣，以增加血供。如果需要一个大的、长的颅骨膜瓣，将瓣做成带蒂的可确保稳定的血供。
