Aronson Sofia, Ellis Marco F
Division of Plastic and Reconstructive Surgery.
Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL.
J Craniofac Surg. 2020 May-Jun;31(3):e309-e312. doi: 10.1097/SCS.0000000000006170.
The use of acellular dermal matrix (ADM) is well established in scalp burn reconstruction. However, its application in at-risk patients and hostile scalp wounds remains controversial and only described in the pediatric setting. This study aims to describe the pre-operative factors leading to the decision to use ADM in adult patients undergoing complex scalp reconstruction, and to describe the postoperative outcomes including wound breakdown and need for reoperation. This is a retrospective case series of patients undergoing scalp reconstruction with use of ADM. Data was collected from operations performed by a single surgeon over a period from January 2017 to October 2018. Nine patients underwent scalp reconstruction including placement of ADM during the study period. Seven patients were female, and median age was 64 years. Six patients had undergone prior craniotomies and three had undergone prior craniectomies for a variety of etiologies including neoplastic disease (n = 4), aneurysmal disease (n = 2), and trauma (n = 3). Wound breakdown or delayed wound healing necessitated reconstructive operations in all patients, 4 of whom had exposed/infected hardware that required removal. The median area of soft tissue defects was 30 cm. Two of the 4 patients with both benign and malignant tumors had been treated with radiation therapy, compromising the quality of the remaining adjacent scalp. Acellular dermal matrix was used in each setting to augment or buttress thin scalp. In 4 patients cranioplasty implants, hardware, or mesh were replaced concurrently. Two patients proceeded onto staged alloplastic cranioplasty without complication. Median follow up was 115 days. During follow up, only 1 patient suffered a major complication requiring reoperation to explant an osteomyelitic bone flap. Acellular dermal matrix can serve as an adjunct in hostile scalp reconstruction. Augmenting the areas of compromised scalp, especially over alloplastic cranioplasty material, can minimize the likelihood of future hardware exposure. Our study demonstrates its use in high-risk scalp wounds defined by frequent operation, chronic infection, and radiation.
脱细胞真皮基质（ADM）在头皮烧伤重建中的应用已得到充分确立。然而，其在高危患者和头皮难愈性伤口中的应用仍存在争议，且仅在儿科环境中有相关描述。本研究旨在描述导致成年患者在接受复杂头皮重建时决定使用ADM的术前因素，并描述术后结果，包括伤口裂开和再次手术的必要性。这是一项对使用ADM进行头皮重建患者的回顾性病例系列研究。数据收集自2017年1月至2018年10月期间由一名外科医生实施的手术。在研究期间，9例患者接受了头皮重建，包括植入ADM。7例为女性，中位年龄为64岁。6例患者曾接受过开颅手术治疗，3例因包括肿瘤性疾病（n = 4）、动脉瘤性疾病（n = 2）和创伤（n = 3）等多种病因接受过颅骨切除术。所有患者均因伤口裂开或伤口愈合延迟而需要进行重建手术，其中4例患者有外露/感染的硬件需要移除。软组织缺损的中位面积为30平方厘米。4例患有良性和恶性肿瘤的患者中有2例接受过放射治疗，这影响了剩余相邻头皮的质量。在每种情况下均使用脱细胞真皮基质来增厚或支撑薄头皮。4例患者同时更换了颅骨成形植入物、硬件或网片。2例患者进行了分期异体颅骨成形术，无并发症发生。中位随访时间为115天。在随访期间，只有1例患者出现严重并发症，需要再次手术取出骨髓炎骨瓣。脱细胞真皮基质可作为头皮难愈性重建的辅助材料。增厚受损头皮区域，尤其是异体颅骨成形材料上方的头皮区域，可降低未来硬件外露的可能性。我们的研究证明了其在因频繁手术、慢性感染和放疗而定义的高危头皮伤口中的应用。
