Sosin Michael, De la Cruz Carla, Bojovic Branko, Christy Michael R, Rodriguez Eduardo D
*Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD †Department of Plastic Surgery, New York University Langone Medical Center, New York, NY.
J Craniofac Surg. 2015 Jun;26(4):1186-91. doi: 10.1097/SCS.0000000000001642.
The purposes of this study were to report a 7-year experience of microvascular reconstruction of scalp defects, compare flap type and outcomes, and evaluate the implications of short and long term complications.
Following institutional review board approval, a single surgeon's patients requiring microvascular scalp reconstruction were retrospectively reviewed from 2005 to 2011. Flap choice, complications, and outcomes were statistically analyzed.
Nineteen patients met inclusion criteria (10 male and 9 female) with a mean age of 60.2 ± 21.4 years (range, 23-90 years). All free tissue transfers (n = 20) achieved 100% soft tissue coverage. Mean size calvarial defect was 106.6 ± 67.2 cm(2) (range, 35-285 cm(2)), with 11 requiring cranioplasty. Free flaps included the following: 13 anteriolateral thigh, 5 ulnar, 1 latissimus dorsi, and 1 thoracodorsal artery perforator. Mean flap size was 154.1 ± 87.3 cm(2) (range, 42-336 cm(2)). Early complications (<30 days following surgery) occurred in 21.1% of patients and late complications (>30 days following surgery) in 52.6% of patients. Patients with an early complication were 2 times more likely to develop a late complication (relative risk, 2.1) but did not reach statistical significance. Late complications were more likely to require surgical intervention, 84.2% versus 60% of early complications (P = 0.079).
Microvascular free tissue transfer is the mainstay of complex scalp defects but carries a high likelihood of future reoperations. Early complications are less concerning than late complications, as the need for future surgical intervention is associated with late complications. There is lack of evidence to support a superior flap choice.
本研究旨在报告7年头皮缺损微血管重建的经验，比较皮瓣类型及结果，并评估短期和长期并发症的影响。
经机构审查委员会批准，对2005年至2011年期间由单一外科医生进行微血管头皮重建的患者进行回顾性研究。对皮瓣选择、并发症及结果进行统计学分析。
19例患者符合纳入标准（男性10例，女性9例），平均年龄60.2±21.4岁（范围23 - 90岁）。所有游离组织移植（n = 20）均实现100%软组织覆盖。颅骨缺损平均面积为106.6±67.2 cm²（范围35 - 285 cm²），其中11例需要颅骨成形术。游离皮瓣包括：13例股前外侧皮瓣、5例尺侧皮瓣、1例背阔肌皮瓣和1例胸背动脉穿支皮瓣。皮瓣平均面积为154.1±87.3 cm²（范围42 - 336 cm²）。21.1%的患者发生早期并发症（术后<30天），52.6%的患者发生晚期并发症（术后>30天）。发生早期并发症的患者发生晚期并发症的可能性高出2倍（相对风险，2.1），但未达到统计学显著性。晚期并发症更有可能需要手术干预，分别为84.2%和60%的早期并发症（P = 0.079）。
微血管游离组织移植是复杂头皮缺损的主要治疗方法，但未来再次手术的可能性很高。早期并发症不如晚期并发症令人担忧，因为未来手术干预的需求与晚期并发症相关。缺乏证据支持某种皮瓣选择更具优势。
