Kim Jin Woo, Woo Soo Hyun, Jang Suk Yoon, Kim Woo Seob, Bae Tae Hui, Kim Han Koo
Department of Plastic and Reconstructive Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.
J Craniofac Surg. 2018 May;29(3):e271-e273. doi: 10.1097/SCS.0000000000004309.
Most patients with reconstruction for extensive scalp defects require the use of a free flap. The suitability of the recipient vessel has a major impact on the surgery and postoperative outcome. Flaps that can be used to reconstruct the total scalp with a single flap include the latissimus dorsi (LD) and omental flaps; the LD flap is generally preferred since the omental flap results in relatively larger donor site morbidity. The recipient vessel most commonly used for scalp defect reconstruction is the superficial temporal vessel. The authors report a patient with successful total scalp reconstruction using a free omental flap on a patient whose bilateral superficial temporal arteries could not be used and who did not have available LD on both sides due to previous LD free flap surgeries for recurrent scalp angiosarcoma. In this patient, direct anastomosis of the flap to the right facial artery was performed without pedicle lengthening, such as vein graft or arteriovenous loops, and favorable outcome was achieved in terms of facial contour after recovery. The free omental flap is useful for reconstruction of extensive scalp defects without additional complex surgical procedures when other flaps are not viable or when the recipient vessel is located at a far distance.
大多数因广泛头皮缺损而需要进行重建手术的患者都需要使用游离皮瓣。受区血管的适用性对手术及术后效果有重大影响。可用于单次皮瓣重建全头皮的皮瓣包括背阔肌（LD）皮瓣和网膜皮瓣；通常更倾向使用LD皮瓣，因为网膜皮瓣会导致相对较大的供区并发症。头皮缺损重建最常用的受区血管是颞浅血管。作者报告了一例患者，该患者双侧颞浅动脉无法使用，且因既往因复发性头皮血管肉瘤行LD游离皮瓣手术，双侧均无可用的LD皮瓣，遂成功使用游离网膜皮瓣进行了全头皮重建。在该患者中，未进行诸如静脉移植或动静脉环等蒂延长操作，而是将皮瓣直接与右侧面动脉进行吻合，术后恢复后面部轮廓良好。当其他皮瓣不可行或受区血管位置较远时，游离网膜皮瓣无需额外复杂的手术操作即可用于广泛头皮缺损的重建。
