Clegg Devin J, Winstead Michael L, Herbig Kathleen S
The Department of Surgery, The University of Tennessee Medical Center, Knoxville, Tenn.
The Department of Oral and Maxillofacial Surgery, The University of Tennessee Medical Center, Knoxville, Tenn.
Plast Reconstr Surg Glob Open. 2020 Jun 23;8(6):e2941. doi: 10.1097/GOX.0000000000002941. eCollection 2020 Jun.
We present the case of a 65-year-old woman with extensive osteoradionecrosis of the scalp and calvaria after external beam radiation therapy for follicular lymphoma. Due to the compromise of her adjacent vasculature including the superficial temporal vessels, she underwent two-stage reconstruction with the creation of an AVL (arteriovenous loop) graft utilizing her great saphenous vein. This was anastomosed to her right facial artery and vein, which was then matured. She underwent resection of the necrotic portions of calvaria and soft tissue of approximately 180 cm2, and a vascularized free latissimus dorsi muscle flap was harvested and anastomosed to her new conduit. This free muscle flap was then covered with a split-thickness skin graft harvested from her thigh. She achieved satisfactory functional and cosmetic results with minimal morbidity and without complication despite her age, multiple co-morbidities, and extensive and complex disease process.
我们报告了一例65岁女性病例，该患者因滤泡性淋巴瘤接受外照射放疗后出现头皮和颅骨广泛放射性骨坏死。由于包括颞浅血管在内的相邻血管受损，她接受了两阶段重建，利用大隐静脉创建了动静脉环（AVL）移植物。将其与右侧面动脉和静脉吻合，然后使其成熟。她接受了约180平方厘米颅骨和软组织坏死部分的切除，并采集了带血管蒂的背阔肌游离皮瓣并与她的新管道吻合。然后用从她大腿采集的中厚皮片覆盖该游离肌皮瓣。尽管她年龄较大、有多种合并症且疾病过程广泛复杂，但她仍取得了令人满意的功能和美容效果，发病率极低且无并发症。
