Wolff Amir Y, Santiago Gabriel F, Belzberg Micah, Manson Paul N, Huang Judy, Brem Henry, Gordon Chad R
Neuroplastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
J Craniofac Surg. 2019 Jan;30(1):115-119. doi: 10.1097/SCS.0000000000004872.
Numerous techniques have been described to overcome scalp deficiency and high-tension closure at time of cranioplasty. However, there is an existing controversy, over when and if a free flap is needed during complex skull reconstruction (ie, cranioplasty). As such the authors present here our experience using full-thickness skin grafts (FTSGs) to cover local defects following scalp adjacent tissue transfer in the setting of cranioplasty.
By way of an institutional review board-approved database, the authors identified patients treated over a 3-year period spanning January 2015 to December 2017, who underwent scalp reconstruction using the technique presented here. Patient demographics, clinical characteristics, technical details, outcomes, and long-term follow up were statistically analyzed for the purpose of this study.
Thirty-three patients, who underwent combined cranioplasty and scalp reconstruction using an FTSG for local donor site coverage, were identified. Twenty-five (75%) patients were considered to have "high complexity" scalp defects prior to reconstruction. Of them, 12 patients (36%) were large-sized and 20 (60%) medium-sized; 21 (64%) grafts were inset over vascularized muscle or pericranium while the remaining grafts were placed over bare calvarial bone. In total, the authors found 94% (31/33) success for all FTSGs in this cohort. Two of the skin grafts failed due to unsuccessful take. Owing to the high rate of success in this series, none of the patient's risk factors were found to correlate with graft failure. In addition, the success rate did not differ whether the graft was placed over bone verses over vascularized muscle/pericranium.
In contrary to previous studies that have reported inconsistent success with full-thickness skin grafting in this setting, the authors present a simple technique with consistent results-as compared to other more complex reconstructive methods-even in the setting of highly complex scalp reconstruction and simultaneous cranioplasty.
为克服颅骨成形术时头皮缺损及高张力缝合问题，已描述了多种技术。然而，在复杂颅骨重建（即颅骨成形术）过程中，何时以及是否需要游离皮瓣存在争议。因此，本文作者介绍我们在颅骨成形术背景下使用全厚皮片（FTSG）覆盖头皮邻近组织转移后的局部缺损的经验。
通过机构审查委员会批准的数据库，作者确定了在2015年1月至2017年12月这3年期间接受使用本文所述技术进行头皮重建的患者。为本研究目的，对患者的人口统计学、临床特征、技术细节、结果及长期随访进行了统计分析。
确定了33例接受颅骨成形术联合使用FTSG覆盖局部供区的头皮重建患者。25例（75%）患者在重建前被认为有“高度复杂”的头皮缺损。其中，12例（36%）为大面积缺损，20例（60%）为中等面积缺损；21例（64%）皮片植入血管化肌肉或颅骨膜上，其余皮片置于裸露的颅骨上。总体而言，作者发现该队列中所有FTSG的成功率为94%（31/33）。2例皮片因未成活而失败。由于本系列成功率高，未发现患者的任何危险因素与皮片失败相关。此外，皮片置于骨上还是血管化肌肉/颅骨膜上，成功率并无差异。
与先前报道在这种情况下全厚皮片移植成功率不一致的研究相反，本文作者介绍了一种简单技术，与其他更复杂的重建方法相比，即使在高度复杂的头皮重建和同期颅骨成形术的情况下，也能取得一致的结果。
