皮肤恶性肿瘤切除术后头皮缺损的闭合手术技术

Surgical Techniques for Closure of a Scalp Defect After Resection of Skin Malignancy.

作者信息

Rysz Maciej, Grzelecki Dariusz, Mazurek Maciej, Starościak Stanisław, Krajewski Romuald

机构信息

*All authors are affiliated with the Department of Head and Neck Cancer, Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.

出版信息

Dermatol Surg. 2017 May;43(5):715-723. doi: 10.1097/DSS.0000000000001067.

DOI:10.1097/DSS.0000000000001067

PMID:28441303

Abstract

BACKGROUND

Surgery for scalp malignancies is aimed at the complete resection and a good aesthetic outcome. The goal was to develop an algorithm for scalp reconstruction based on the authors' surgical experience.

METHODS

This is a retrospective analysis of 123 procedures of scalp malignancies in 105 patients. Twenty eight procedures were for resection of squamous cell carcinoma, 54 for basal cell carcinoma, and 41 for suspected melanomas.

RESULTS

Primary closure (27 procedures), local flap (LF; 19), split-thickness skin graft (SG; 64), rotated LF and SG (9), and free vascularized flaps (4) were used. Complications were partial (4) and total (1) necrosis of SG, free-flap atrophy (1), infection (2), wound dehiscence (1), and death due to cardiovascular complications (1). During follow-up, recurrence occurred in 22 patients (21%) and metastases to lymph nodes in 3 (3%).

CONCLUSION

Surface area size and the presence of the periosteum as well as a bone infiltration are important factors that can guide selection of a reconstruction method after resection of scalp malignancy.

摘要

背景

头皮恶性肿瘤手术旨在实现完整切除并获得良好的美学效果。目标是基于作者的手术经验制定一种头皮重建算法。

方法

这是一项对105例患者的123例头皮恶性肿瘤手术的回顾性分析。其中28例为鳞状细胞癌切除术，54例为基底细胞癌切除术，41例为疑似黑色素瘤切除术。

结果

采用了一期缝合（27例手术）、局部皮瓣（LF；19例）、中厚皮片移植（SG；64例）、旋转局部皮瓣和中厚皮片移植（9例）以及游离带血管皮瓣（4例）。并发症包括中厚皮片部分（4例）和完全（1例）坏死、游离皮瓣萎缩（1例）、感染（2例）、伤口裂开（1例）以及因心血管并发症死亡（1例）。随访期间，22例患者（21%）出现复发，3例（3%）发生淋巴结转移。