使用真皮再生模板修复全层头皮缺损
Reconstruction of Full-Thickness Scalp Defects Using a Dermal Regeneration Template.
作者信息
Richardson Matthew A, Lange Jessica P, Jordan J Randall
机构信息
Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson.
出版信息
JAMA Facial Plast Surg. 2016 Jan-Feb;18(1):62-7. doi: 10.1001/jamafacial.2015.1731.
IMPORTANCE
Large full-thickness scalp defects pose a reconstructive problem and commonly require microvascular free flap reconstruction.
OBJECTIVE
To describe a novel and effective reconstructive technique for full-thickness scalp defects that can be performed quickly without general anesthesia or free flap reconstruction.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of 10 patients at a single medical center who underwent surgical resection of a cutaneous lesion. Reconstruction of the large scalp defects included application of Integra bilayer wound matrix followed by delayed split-thickness skin grafting from January 1, 2008, to December 31, 2014. Patients ranged in age from 50 to 87 (mean, 71.5) years; 8 (80%) were men. Mean duration of follow-up was 481.1 days (range, 41-1199 days).
MAIN OUTCOMES AND MEASURES
Skin graft viability and adherence to underlying tissue (take) and postoperative complications.
RESULTS
The 10 patients in this study had excellent skin graft and wound closure outcomes. Nine patients showed a 100% initial take of the skin graft to the defect site. Only 1 patient showed a 95% to 100% initial take. Adequate coverage of the wound bed was achieved with acceptable cosmetic results. Two patients underwent postoperative intensity-modulated radiotherapy. One of these patients experienced radiotherapy-induced wound breakdown 3½ months after completion of therapy, which resolved completely after more than 6 months.
CONCLUSIONS AND RELEVANCE
This novel technique for reconstruction of large full-thickness scalp defects has low morbidity and can be performed on an outpatient basis with minimal wound care. The technique provides the surgeon with an alternative to other reconstructive options, including microvascular free tissue transfer, for repair of large full-thickness scalp defects. The procedure has excellent results and can be performed under sedation and local anesthesia, which avoids the risks associated with general anesthesia.
LEVEL OF EVIDENCE
重要性
大面积全层头皮缺损带来了重建难题，通常需要微血管游离皮瓣重建。
目的
描述一种用于全层头皮缺损的新颖且有效的重建技术，该技术可在无需全身麻醉或游离皮瓣重建的情况下快速实施。
设计、场所和参与者：对一家单一医疗中心10例行皮肤病变手术切除患者的回顾性研究。2008年1月1日至2014年12月31日期间，对大面积头皮缺损进行重建包括应用Integra双层伤口基质，随后进行延迟性断层皮片移植。患者年龄范围为50至87岁（平均71.5岁）；8例（80%）为男性。平均随访时间为481.1天（范围41至1199天）。
主要结局和测量指标
皮片存活情况、与下方组织的粘连情况（成活）以及术后并发症。
结果
本研究中的10例患者皮片及伤口闭合效果极佳。9例患者皮片在缺损部位的初始成活率为100%。仅1例患者初始成活率为95%至100%。伤口床得到充分覆盖，美容效果可接受。2例患者接受了术后调强放疗。其中1例患者在治疗完成后3个半月出现放疗诱发的伤口破溃，6个多月后完全愈合。
结论及相关性
这种用于大面积全层头皮缺损重建的新技术发病率低，可在门诊进行，伤口护理极少。该技术为外科医生提供了一种替代其他重建方法（包括微血管游离组织移植）来修复大面积全层头皮缺损的选择。该手术效果极佳，可在镇静和局部麻醉下进行，避免了全身麻醉相关的风险。
证据级别
4级。
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