Cho Gerald J, Wang Frederick, Garcia Steven M, Viner Jennifer, Hoffman William Y, McDermott Michael W, Pomerantz Jason H
*Division of Plastic and Reconstructive Surgery, Department of Surgery †Department of Neurological Surgery, University of California San Francisco, San Francisco, CA.
J Craniofac Surg. 2017 Mar;28(2):325-330. doi: 10.1097/SCS.0000000000003384.
Recurrent invasive skin cancer of the scalp and calvarium is a difficult problem for which universally accepted treatment protocols have not been established. The authors present their 10-year experience with treatment of this specific subset of scalp reconstruction patients and present a successful treatment algorithm that is well suited to this patient population.
The authors retrospectively reviewed all patients of microsurgical scalp reconstruction performed from 2005 to 2015 that involved invasive cutaneous malignancies of the scalp and calvarium.
Eleven patients met inclusion criteria. There were 9 squamous cell carcinoma, 1 basal cell carcinoma, and 1 melanoma. Seven received radiation prior to resection, 2 were irradiated postoperatively, and 2 were immunosuppressed. Seven had a history of prior scalp reconstruction. The median scalp defect size was 141 cm. All the patients underwent craniectomy and the median cranial defect size was 71 cm. Cranioplasty was not performed in any patient. There were no intraoperative complications or flap loss. Recipient site complications included hematoma in 1, 1 seroma, 2 cerebral spinal fluid leaks, 3 partial skin graft loss. There was 1 donor site seroma in a patient who had a latissimus dorsi flap. All the patients reported satisfaction with the overall result and none were limited in activities by the existing cranial defect.
This is the largest series published to date that focuses exclusively on management of cutaneous malignancies with intracranial invasion. Wide resection with craniectomy, and reconstruction with microvascular free tissue transfer without cranioplasty provides safe and reliable treatment of recalcitrant invasive scalp skin cancers with low morbidity and without major complications. Pre and postoperative radiation is well tolerated with this approach. The patients in this series were of advanced age and of a lifestyle for which cranioplasty is unnecessary for return to regular activities.
复发性头皮和颅骨侵袭性皮肤癌是一个难题，尚未建立普遍接受的治疗方案。作者介绍了他们在治疗这一特定头皮重建患者亚组方面的10年经验，并提出了一种非常适合该患者群体的成功治疗算法。
作者回顾性分析了2005年至2015年期间所有接受显微外科头皮重建的患者，这些患者均涉及头皮和颅骨的侵袭性皮肤恶性肿瘤。
11例患者符合纳入标准。其中9例为鳞状细胞癌，1例为基底细胞癌，1例为黑色素瘤。7例在切除术前接受过放疗，2例术后接受放疗，2例免疫抑制。7例有先前头皮重建史。头皮缺损的中位大小为141平方厘米。所有患者均接受了颅骨切除术，颅骨缺损的中位大小为71平方厘米。所有患者均未进行颅骨成形术。术中无并发症或皮瓣丢失。受区并发症包括1例血肿、1例血清肿、2例脑脊液漏、3例部分皮肤移植失败。1例背阔肌皮瓣患者出现供区血清肿。所有患者对总体结果均表示满意，且均未因现有颅骨缺损而限制活动。
这是迄今为止发表的最大系列研究，专门关注颅内侵犯的皮肤恶性肿瘤的管理。广泛切除并颅骨切除，采用微血管游离组织移植重建且不进行颅骨成形术，可为顽固性侵袭性头皮皮肤癌提供安全可靠的治疗，发病率低且无重大并发症。这种方法对术前和术后放疗耐受性良好。该系列患者年龄较大，且其生活方式无需进行颅骨成形术即可恢复日常活动。
