Jayapaul Pushkaran, Lee Jung Ho, Park Ik Seong
Department of Neurosurgery, Saveetha Medical College & Hospital, Saveetha University, Chennai, India.
Department of Plastic and Reconstructive Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon-si, Gyeonggi-do, Republic of Korea.
World Neurosurg. 2018 Dec;120:185-189. doi: 10.1016/j.wneu.2018.08.221. Epub 2018 Sep 7.
Combined revascularization is the preferred surgical management of adult Moyamoya disease. However, postoperative flap necrosis of the scalp is not an uncommon complication. We investigated the role of scalp incision design on the basis of the course of the superficial temporal artery (STA) to prevent postoperative scalp necrosis. The utility of tissue expander in wide scalp defect repair is explored.
A 13-year-old female patient underwent STA-to-middle cerebral artery anastomosis and encephaloduroarteriosynangiosis due to ischemic symptoms. However, she suffered from wide scalp necrosis measuring 10.5 × 10 cm after bypass surgery. Conventional rotational scalp flap reconstruction was impossible due to the wide defect, and therefore split thickness skin graft was considered. However, aesthetic compromise or hair loss is a psychologic burden in an adolescent female. Two tissue expanders were inserted under the contralateral normal scalp, and a gradual expansion was achieved by saline infusion for 3 months. Finally, a wide scalp flap, which covered the large defect, was obtained using this procedure. The patient underwent rotational flap advancement and was discharged without any hair loss wound.
Miserable scalp flap design results in a large scalp defect during combined bypass surgery. However, tissue expanders aided the reconstruction of a large scalp defect. Reconstruction using tissue expanders and advancement of local rotation flap is recommended in case of large scalp necrosis. The procedure yields cosmetically superior outcomes due to scalp hair conservation and concealment of postoperative scar behind the hair line.
联合血运重建是成人烟雾病首选的手术治疗方法。然而，术后头皮皮瓣坏死是一种并不少见的并发症。我们基于颞浅动脉（STA）走行研究了头皮切口设计在预防术后头皮坏死中的作用。探讨了组织扩张器在大面积头皮缺损修复中的应用价值。
一名13岁女性患者因缺血症状接受了STA - 大脑中动脉吻合术和脑硬脑膜动脉血管融通术。然而，搭桥手术后她出现了面积为10.5×10 cm的大面积头皮坏死。由于缺损范围广，无法进行传统的旋转头皮皮瓣重建，因此考虑采用断层皮片移植。然而，美观受损或脱发对青春期女性来说是一种心理负担。在对侧正常头皮下植入了两个组织扩张器，通过注入生理盐水进行了3个月的逐步扩张。最后，采用该方法获得了覆盖大面积缺损的宽头皮皮瓣。患者接受了旋转皮瓣推进术，出院时伤口无脱发情况。
在联合搭桥手术中，糟糕的头皮皮瓣设计会导致大面积头皮缺损。然而，组织扩张器有助于大面积头皮缺损的重建。对于大面积头皮坏死，建议采用组织扩张器重建并推进局部旋转皮瓣。由于保留了头皮毛发且术后瘢痕隐藏在发际线后缘，该手术在美容方面效果更佳。
