Han F, Zheng Z, Wang H T, Guan H, Ji P, Hu X L, Tong L, Zhang Z, Chen Q H, Feng A N, Hu D H
Department of Burns and Cutaneous Surgery, Burn Center of PLA, Xijing Hospital, Air Force Medical University, Xi'an 710032, China.
Zhonghua Shao Shang Za Zhi. 2020 Mar 20;36(3):219-223. doi: 10.3760/cma.j.cn501120-20190505-00222.
To evaluate the clinical effects of anterolateral thigh free flap with fascia lata in the repair of dura mater defect after resection of head squamous cell carcinoma. From June 2016 to June 2018, Xijing Hospital of Air Force Medical University applied the free transplantation of anterolateral thigh flap with fascia lata to repair the dura mater defect of 12 patients with head squamous cell carcinoma, including 9 males and 3 females, aged from 35 to 74 years. The size of scalp soft tissue defects in patients after carcinoma resection ranged from 12 cm×10 cm to 24 cm×21 cm, and the size of dura mater defect of patients ranged from 7 cm×6 cm to 16 cm×14 cm. The size of flap of patients ranged from 14 cm×12 cm to 27 cm×24 cm, and the size of fascia lata ranged from 8 cm×7 cm to 17 cm×15 cm. The superficial temporal artery and middle temporal vein were connected by end to end anastomosis with the first musculocutaneous perforating branch of the descending branch of lateral femoral artery and its accompanying vein. The flap donor area was transplanted with autologous split-thickness skin graft from trunk and fixed with packing. Postoperative survival of flaps and skin grafts was observed. The patients were followed up regularly. The cranial magnetic resonance imaging was performed to observe the recurrence of intracranial tumors and dural integrity, shape of the flap and whether the donor site region was left with significant dysfunction were observed. All the flaps and skin grafts survived well in 12 patients after surgery. Ten patients had primary healing at the edge of the flap suture; 2 patients had local sinus tract formation at the suture site of flap, with a small amount of cerebrospinal fluid leakage, and were recovered after outpatient dressing change. The patients were followed up for 10 to 36 months, and 3 patients with tumors involving in the dura mater sagittal sinus region had postoperative intracranial tumor recurrence. The tumor was resected again. All the patients had good dural integrity. The flaps of all patients were in good shape, and no obvious dysfunction remained in the flap donor site. Free transplantation of anterolateral thigh flap with fascia lata is an effective and reliable method to repair the dura mater defect following head squamous cell carcinoma resection. It can repair the scalp and dura mater defects caused by the invasion of squamous cell carcinoma and provide possibilities for skull reconstruction.
评估带阔筋膜的股前外侧游离皮瓣修复头颈部鳞状细胞癌切除术后硬脑膜缺损的临床效果。2016年6月至2018年6月，空军军医大学西京医院应用带阔筋膜的股前外侧皮瓣游离移植修复12例头颈部鳞状细胞癌患者的硬脑膜缺损，其中男9例，女3例，年龄35～74岁。癌切除术后患者头皮软组织缺损大小为12 cm×10 cm至24 cm×21 cm，硬脑膜缺损大小为7 cm×6 cm至16 cm×14 cm。患者皮瓣大小为14 cm×12 cm至27 cm×24 cm，阔筋膜大小为8 cm×7 cm至17 cm×15 cm。将颞浅动脉和颞中静脉与股外侧动脉降支的第一肌皮穿支及其伴行静脉端端吻合。皮瓣供区采用躯干自体中厚皮片移植并打包固定。观察术后皮瓣及植皮存活情况。对患者进行定期随访。行头颅磁共振成像观察颅内肿瘤复发及硬脑膜完整性，观察皮瓣形态及供区有无明显功能障碍。12例患者术后皮瓣及植皮全部存活良好。10例患者皮瓣缝合边缘一期愈合；2例患者皮瓣缝合处局部形成窦道，有少量脑脊液漏，经门诊换药后愈合。患者随访10～36个月，3例累及硬脑膜矢状窦区的肿瘤患者术后颅内肿瘤复发，再次行肿瘤切除。所有患者硬脑膜完整性良好。所有患者皮瓣形态良好，皮瓣供区无明显功能障碍。带阔筋膜的股前外侧皮瓣游离移植是修复头颈部鳞状细胞癌切除术后硬脑膜缺损的一种有效可靠的方法。它能修复鳞状细胞癌侵犯所致的头皮和硬脑膜缺损，为颅骨重建提供可能。
