Weitz Jochen, Spaas Christophe, Wolff Klaus-Dietrich, Meyer Bernhard, Shiban Ehab, Ritschl Lucas M
Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany.
Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
Front Oncol. 2019 Oct 25;9:1130. doi: 10.3389/fonc.2019.01130. eCollection 2019.
Reconstructions of complex scalp after ablative resection or by post-traumatic tissue loss, can present difficulties regarding recipient vessel selection, functional, and aesthetic outcome. The harvesting method for many microvascular free flaps requires a need for changing patients position during surgery and makes a simultaneous interdisciplinary two-team approach complicated, which is a major disadvantage regarding safety and operation time. The ideal flap for scalp reconstruction has yet to be described, although the microvascular latissimus dorsi flap is frequently referred to as the first choice in this context, especially after resection of large defects. The purpose of this study is to compare two different microvascular free flaps for a simultaneous scalp reconstruction in an interdisciplinary two-team approach applying a standardized algorithm. All consecutively operated complex scalp defects after ablative surgery from April 2017 until August 2018 were included in this retrospective study. The indications were divided into neoplasm or wound healing disorder. Two microvascular flaps (latissimus dorsi or parascapular flap) were used to cover the soft tissue component of the resulting defects. Seventeen patients met the inclusion criterion and were treated in an interdisciplinary two-team approach. Skull reconstruction with a CAD/CAM implant was performed in 10 cases of which four were in a secondary stage. Nine patients received a parascapular flap and eight patients were treated with latissimus dorsi flap with split thickness skin graft. Anastomosis was performed with no exception to the temporal vessels. One parascapular flap had venous insufficiency after 1 week followed by flap loss. One latissimus dorsi flap had necrosis of the serratus part of the flap. All other flaps healed uneventful and could be further treated with adjuvant therapy or CAD/CAM calvarial implants. Regarding overall complications, flap related complications, flap loss, and inpatient stay no statistical differences were seen between the diagnosis or type of reconstruction. The parascapular flap seems to be a good alternative for reconstruction of complex tumor defects of the scalp besides the latissimus dorsi flap. Stable long-term results and little donor site morbidity are enabled with good aesthetic outcomes and shorter operation time in an interdisciplinary two-team approach.
在进行切除性手术后或因创伤导致组织缺损而重建复杂头皮时，在受区血管选择、功能和美学效果方面可能会遇到困难。许多微血管游离皮瓣的切取方法需要在手术过程中改变患者体位，这使得同时采用跨学科双团队方法变得复杂，这在安全性和手术时间方面是一个主要缺点。尽管背阔肌微血管皮瓣在这种情况下常被称为首选皮瓣，尤其是在切除大的缺损后，但用于头皮重建的理想皮瓣尚未被描述。本研究的目的是在跨学科双团队方法中应用标准化算法，比较两种不同的微血管游离皮瓣用于同步头皮重建的效果。本回顾性研究纳入了2017年4月至2018年8月期间所有接受连续性手术的切除性手术后复杂头皮缺损病例。适应证分为肿瘤或伤口愈合障碍。使用两种微血管皮瓣（背阔肌或肩胛旁皮瓣）覆盖所产生缺损的软组织部分。17例患者符合纳入标准，并采用跨学科双团队方法进行治疗。10例患者进行了CAD/CAM植入物颅骨重建，其中4例为二期手术。9例患者接受了肩胛旁皮瓣，8例患者接受了带断层皮片移植的背阔肌皮瓣治疗。所有病例均与颞部血管进行了吻合。1例肩胛旁皮瓣在术后1周出现静脉功能不全，随后皮瓣坏死。1例背阔肌皮瓣出现皮瓣锯齿肌部分坏死。所有其他皮瓣均顺利愈合，可进一步接受辅助治疗或CAD/CAM颅骨植入物治疗。在诊断或重建类型之间，在总体并发症、皮瓣相关并发症、皮瓣坏死和住院时间方面未观察到统计学差异。除背阔肌皮瓣外，肩胛旁皮瓣似乎是重建头皮复杂肿瘤缺损的一个良好替代方案。在跨学科双团队方法中，能够获得稳定的长期效果，供区并发症少，美学效果良好，手术时间短。
