Lamaris Gregory A, Knackstedt Rebecca, Couto Rafael A, Abedi Nasim, Durand Paul, Gastman Brian
Department of Plastic and Reconstructive Surgery, The Cleveland Clinic Foundation, Cleveland, OH.
J Craniofac Surg. 2017 Mar;28(2):472-476. doi: 10.1097/SCS.0000000000003404.
Large scalp soft tissue defects can present difficulties with reconstruction. The ideal flap for scalp reconstruction has yet to be described although the latissimus dorsi flap is frequently referred to as the first choice in this setting.
Following institutional review board approval, the authors reviewed their experience in scalp reconstruction for the past 4 years. Patient demographics, reconstruction indication, flap choice, complications, and outcomes were recorded.
Thirteen patients underwent scalp reconstruction with an anterolateral thigh (ALT) free flap. In most patients, the indication was resection of a cutaneous malignancy. In all but 1 patient the facial or more proximal vessels were used for anastomosis. None of the patients required vein grafts to increase pedicle length. The median flap surface area was 156 cm. One flap had vascular compromise. All donor sites healed without complications.
The ALT flap can emerge as the flap of choice for scalp reconstruction, even when proximal neck vessels are used as the recipient targets. Using a suprafascial dissection and extending the vascular pedicle to the profunda femoris artery can optimize its role in this setting. The ALT flap provides excellent cosmesis and durable scalp coverage with minimal donor site morbidity.
大面积头皮软组织缺损的重建存在困难。尽管背阔肌皮瓣在这种情况下常被视为首选，但尚未有理想的头皮重建皮瓣被描述。
经机构审查委员会批准后，作者回顾了过去4年中他们在头皮重建方面的经验。记录了患者的人口统计学数据、重建指征、皮瓣选择、并发症及结果。
13例患者接受了股前外侧（ALT）游离皮瓣进行头皮重建。在大多数患者中，指征为切除皮肤恶性肿瘤。除1例患者外，其余均使用面部或更近端的血管进行吻合。无一例患者需要静脉移植来增加蒂的长度。皮瓣表面积中位数为156平方厘米。1例皮瓣出现血管危象。所有供区均愈合良好，无并发症。
即使将近端颈部血管作为受区靶点，ALT皮瓣也可成为头皮重建的首选皮瓣。采用筋膜上分离并将血管蒂延伸至股深动脉可优化其在这种情况下的作用。ALT皮瓣可提供极佳的美容效果和持久的头皮覆盖，且供区并发症最少。
