Department of Plastic Surgery, University Federico II, Via Pansini 9, 80100, Naples, Italy.
Department of Maxillofacial Surgery, University Federico II, Via Pansini 9, 80100, Naples, Italy.
Surg Oncol. 2020 Mar;32:49-56. doi: 10.1016/j.suronc.2019.10.016. Epub 2019 Oct 25.
Reconstruction of scalp defects can be performed with local flaps for medium to large defects (2-25 cm) and microvascular free flaps for extensive full-thickness scalp reconstruction greater than 25 cm. Doppler flowmetry with its ability to exactly mark the course of arteries on the overlying skin, is a useful tool for the surgical planning of large local flaps. In our retrospective study conducted on 38 patients (all patients had malignancies or post-traumatic scalp defects), consisting of 39 total surgical procedures, we studied the impact of doppler ultrasonic flowmetry in the surgical planning for pedicled flaps in extensive full-thickness scalp reconstruction (>25 cm) by evaluating overall flap survival rate. Nine different types of local flaps were employed in the scalp reconstruction: Superficial temporal artery (STA) pedicled rotation flap, STA pedicled transposition flap, STA islanded flap, bipedicled STA flap, bipedicled fronto-occipital flap, Supraorbital/Supratrochlear artery rotation flap, Supraorbital/Supratrochlear artery transposition flap, Occipital artery (OA) pedicled rotation flap, OA pedicled transposition flap. Before each surgical procedure a hand held doppler Huntleigh Diagnostic flowmeter with a 8 MHz probe was used to identify and follow the course of the arteries. Flap survival rate was 100%. No postoperative complications related to the flap were reported, while in two patients a partial skin graft failure occurred.
头皮缺损的重建可以采用局部皮瓣进行，适用于中到大的缺损（2-25cm），或采用游离微血管皮瓣进行广泛的全层头皮重建，缺损大于 25cm。多普勒血流仪能够准确标记覆盖皮肤的动脉走行，是大型局部皮瓣手术规划的有用工具。在我们对 38 名患者（所有患者均有恶性肿瘤或创伤后头皮缺损）进行的回顾性研究中，共进行了 39 次手术，我们通过评估总皮瓣存活率来研究多普勒超声血流仪在广泛全层头皮重建（>25cm）中带蒂皮瓣手术规划中的影响。头皮重建中采用了 9 种不同类型的局部皮瓣：颞浅动脉（STA）带蒂旋转皮瓣、STA 带蒂移位皮瓣、STA 岛状皮瓣、双蒂 STA 皮瓣、双蒂额枕皮瓣、眶上/滑车上动脉旋转皮瓣、眶上/滑车上动脉移位皮瓣、枕动脉（OA）带蒂旋转皮瓣、OA 带蒂移位皮瓣。在每次手术前，使用手持式 Huntleigh Diagnostic 多普勒流量仪和 8MHz 探头识别并追踪动脉的走行。皮瓣存活率为 100%。未报告与皮瓣相关的术后并发症，而在 2 名患者中发生了部分皮肤移植物失败。
