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脑室腹腔分流管上方的颅骨缺损：压力梯度会导致游离皮瓣恶化吗？

Cranial Defect Overlying a Ventriculoperitoneal Shunt: Pressure Gradient Leading to Free Flap Deterioration?

作者信息

Joo Jae Doo, Jang Jin-Uk, Kim Hyonsurk, Yoon Eul-Sik, Kang Dong Hee

机构信息

Department of Plastic and Reconstructive Surgery, Dankook University College of Medicine, Cheonan, Korea.

Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

出版信息

Arch Craniofac Surg. 2017 Sep;18(3):186-190. doi: 10.7181/acfs.2017.18.3.186. Epub 2017 Sep 26.

DOI:10.7181/acfs.2017.18.3.186
PMID:29090200
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5647847/
Abstract

We report a case of free flap deterioration which may have been induced by pressure gradient resulting from cranial defect overlying a ventriculoperitoneal shunt (VP shunt). The patient, male and aged 78, had a VP shunt operation for progressive hydrocephalus. Afterwards, the scalp skin flap surrounding the VP shunt collapsed and showed signs of necrosis, exposing part of the shunt catheter. After covering the defect with a radial forearm free flap, the free flap site showed signs of gradual sinking while the vascularity of the flap remained unimpaired. An agreement was reached to remove the shunt device and observe the patient for any neurological symptoms, and after the shunt was removed and the previous cranial opening filled with fibrin glue by Neurosurgery, we debrided the deteriorated flap and provided coverage with 2 large opposing rotational flaps. During 2 months' outpatient follow-up no neurological symptoms appeared, and the new scalp flap displayed slight depression but remained intact. The patient has declined from any further follow-up since.

摘要

我们报告一例游离皮瓣恶化病例，可能是由脑室腹腔分流术（VP分流术）上方颅骨缺损导致的压力梯度引起的。患者为78岁男性，因进行性脑积水接受了VP分流术。术后，VP分流术周围的头皮皮瓣塌陷并出现坏死迹象，部分分流导管外露。在用桡侧前臂游离皮瓣覆盖缺损后，游离皮瓣部位出现逐渐下沉的迹象，而皮瓣的血运未受影响。经协商决定移除分流装置并观察患者有无神经症状，在分流装置移除且神经外科用纤维蛋白胶填充先前的颅骨开口后，我们对恶化的皮瓣进行清创，并用两个大型对向旋转皮瓣覆盖。在2个月的门诊随访中未出现神经症状，新的头皮皮瓣有轻微凹陷但保持完整。此后患者拒绝进一步随访。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/1771e075a065/acfs-18-186-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/7fa38b0d0f13/acfs-18-186-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/057f4c4cf36c/acfs-18-186-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/f561ecb9ce0d/acfs-18-186-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/078680867937/acfs-18-186-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/1771e075a065/acfs-18-186-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/7fa38b0d0f13/acfs-18-186-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/057f4c4cf36c/acfs-18-186-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/f561ecb9ce0d/acfs-18-186-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/078680867937/acfs-18-186-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f0f/5647847/1771e075a065/acfs-18-186-g005.jpg

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本文引用的文献

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Scalp necrosis overlying a ventriculoperitoneal shunt: a case report and literature review.脑室腹腔分流术上方头皮坏死：一例报告及文献复习
Dermatol Online J. 2015 Oct 16;21(10):13030/qt2rs544f9.
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Sinking skin flap syndrome (or Syndrome of the trephined): A review.皮肤瓣下陷综合征（或环钻综合征）：综述
Br J Neurosurg. 2015 Jun;29(3):314-8. doi: 10.3109/02688697.2015.1012047. Epub 2015 Feb 27.
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Scalp reconstruction: an algorithmic approach and systematic review.头皮重建：一种算法方法及系统评价
First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant.
首例将脑积水引流装置与定制颅骨植入物整合的人体试验经验
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