He Yongjing, Wang Jihua, Yang Yun, Liu Yin, Zhang Jingbo, Zhu Likun, Guo Shuzhong, Zhu Jianping, Liu Hongli
Department of Plastic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Mar;27(3):299-303.
To investigate the clinical value of computed tomographic angiography (CTA) and three-dimensional reconstruction technique in repairing scalp avulsion wound with large skull exposure by the free latissimus dorsi flap transplantation.
Between October 2007 and June 2012, 9 female patients with serious scalp avulsion and large skull exposure were treated, aged 23-54 years (mean, 38 years). The injury causes included machine twist injury in 6 cases, traffic accident injury in 2 cases, and falling from height injury in 1 case. Before admission, 3 patients had scalp necrosis after scalp in situ replantation, and 6 patients underwent debridement and dressing. The time from injury to admission was 8 hours to 7 days (mean, 1 day). The avulsed scalp area ranged from 75% to 90% of the scalp area (mean, 81%); the exposed skull area ranged from 55% to 70% of the scalp area (mean, 63%). Two patients had unilateral auricle avulse. CTA was used to observe the superficial temporal artery and vein, facial artery, external jugular vein, dorsal thoracic artery and vein, and measure the blood vessel diameter before operation. According to the CTA results, the latissimus dorsal skin flaps were desinged to repair wounds in 7 cases, the latissimus dorsal muscle flaps combined with skin graft were used to repair wounds in 2 cases. According to preoperative design, operation was successfully completed in 7 cases; great saphenous vein was used as vascular graft in 2 cases having poor images of superficial temporal vessels. The size of latissimus dorsal skin flaps ranged from 20 cm x 14 cm to 25 cm x 20 cm; the donor site was repaired with skin graft. The size of latissimus dorsal muscle flaps were 23 cm x 16 cm and 16 cm x 10 cm; the donor site was directly sutured.
The blood vessel diameter measured during operation was close to the value measured before operation. The operation time was 6-8 hours (mean, 6.5 hours). The latissimus dorsal muscle (skin) flap and skin graft survived, with primary healing of wound or incision at donor site. The patients were followed up 3 months-2 years (mean, 6 months). The flap had soft texture and skin had no ulceration.
The free latissimus dorsi flaps can repair scalp avulsion with large skull exposure. Preoperative CTA can get the vessel anatomical structure and diameter at donor and recipient sites, which will guide the operation program design and implementation so as to shorten the operation time and improve the accuracy rate of vascular anastomosis.
探讨计算机断层血管造影（CTA）及三维重建技术在游离背阔肌皮瓣移植修复大面积颅骨外露头皮撕脱伤中的临床应用价值。
2007年10月至2012年6月，收治9例女性严重头皮撕脱伴大面积颅骨外露患者，年龄23～54岁，平均38岁。致伤原因：机器绞伤6例，交通事故伤2例，高处坠落伤1例。入院前3例头皮原位再植后发生头皮坏死，6例行清创换药。受伤至入院时间8小时至7天，平均1天。撕脱头皮面积占头皮面积的75%～90%，平均81%；颅骨外露面积占头皮面积的55%～70%，平均63%。2例伴有单侧耳廓撕脱。术前采用CTA观察颞浅动静脉、面动脉、颈外静脉、胸背动静脉，并测量血管直径。根据CTA结果，7例行背阔肌皮瓣修复创面，2例行背阔肌肌瓣联合植皮修复创面。按术前设计，7例手术顺利完成；2例颞浅血管图像不佳者采用大隐静脉作为血管移植。背阔肌皮瓣大小为20 cm×14 cm～25 cm×20 cm，供区植皮修复。背阔肌肌瓣大小分别为23 cm×16 cm和16 cm×10 cm，供区直接缝合。
术中测量血管直径与术前测量值相近。手术时间6～8小时，平均6.5小时。背阔肌（皮）瓣及植皮成活，供区伤口或切口一期愈合。患者随访3个月至2年，平均6个月。皮瓣质地柔软，皮肤无溃疡。
游离背阔肌皮瓣可修复大面积颅骨外露头皮撕脱伤。术前CTA可了解供区及受区血管解剖结构及直径，指导手术方案设计及实施，从而缩短手术时间，提高血管吻合准确率。
