Shay Tamir, Har-Shai Lior, Cohen Avi A, Ad-El Dean D
Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikva, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Craniofac Surg. 2019 Nov-Dec;30(8):e746-e748. doi: 10.1097/SCS.0000000000005754.
Full-thickness large scalp defects with underlying exposed calvarium pose a significant reconstructive challenge. Traditional reconstructive techniques are usually not an option in patients with irradiated scalp with thin skin and reduced laxity.Dermal substitutes-based reconstruction techniques have been described in recent years. A common approach is the staged methodology, with the initial application of skin substitute followed by a split-thickness skin graft few weeks later; however, this method involves a prolonged period of local wound management prior to skin grafting and is often associated with complications that interfere with wound healing.This report describes a single-stage triple-layer technique for the reconstruction of a large scalp defect with exposed bone in a patient with a history of radiation treatment, using 3 turnover pericranial flaps in conjunction with a Matriderm dermal substitute and split-thickness skin graft. This immediate multilayered reconstruction provides a long-lasting structural and aesthetic outcome, with minimal donor site morbidity and reduced complications.
伴有颅骨外露的全层大面积头皮缺损给重建带来了重大挑战。对于皮肤薄且松弛度降低的放疗后头皮患者，传统的重建技术通常不可行。近年来已有基于真皮替代物的重建技术的相关报道。一种常见的方法是分阶段进行，先应用皮肤替代物，几周后再进行断层皮片移植；然而，这种方法在皮片移植前需要长时间的局部伤口处理，且常伴有干扰伤口愈合的并发症。本报告描述了一种单阶段三层技术，用于重建一名有放疗史且颅骨外露的大面积头皮缺损患者，该技术使用3个翻转颅骨膜瓣联合Matriderm真皮替代物和断层皮片移植。这种即时的多层重建提供了持久的结构和美学效果，供区并发症最少且并发症减少。
