Kwiecien Grzegorz J, Sinclair Nicholas, Coombs Demetrius M, Djohan Risal S, Mihal David, Zins James E
Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio.
Plast Reconstr Surg Glob Open. 2020 Aug 25;8(8):e3031. doi: 10.1097/GOX.0000000000003031. eCollection 2020 Aug.
Scalp thinning over a cranioplasty can lead to complex wound problems, such as extrusion and infection. However, the details of this process remain unknown. The aim of this study was to describe long-term soft-tissue changes over various cranioplasty materials and to examine risk factors associated with accelerated scalp thinning.
A retrospective review of patients treated with isolated cranioplasty between 2003 and 2015 was conducted. To limit confounders, patients with additional scalp reconstruction or who had a radiologic follow-up for less than 1 year were excluded. Computed tomography or magnetic resonance imaging was used to measure scalp thickness in identical locations and on the mirror image side of the scalp at different time points.
One hundred one patients treated with autogenous bone (N = 38), polymethylmethacrylate (N = 33), and titanium mesh (N = 30) were identified. Mean skull defect size was 104.6 ± 43.8 cm. Mean length of follow-up was 5.6 ± 2.6 years. Significant thinning of the scalp occurred over all materials ( < 0.05). This was most notable over the first 2 years after reconstruction. Risk factors included the use of titanium mesh ( < 0.05), use of radiation ( < 0.05), reconstruction in temporal location ( < 0.05), and use of a T-shaped or "question mark" incision ( < 0.05).
Thinning of the native scalp occurred over both autogenous and alloplastic materials. This process was more severe and more progressive when titanium mesh was used. In our group of patients without preexisting soft-tissue problems, native scalp atrophy rarely led to implant exposure. Other risk factors for scalp atrophy included radiation, temporal location, and type of surgical exposure.
颅骨修补术后头皮变薄可导致复杂的伤口问题，如植入物外露和感染。然而，这一过程的细节仍不清楚。本研究的目的是描述各种颅骨修补材料上的长期软组织变化，并检查与加速头皮变薄相关的危险因素。
对2003年至2015年间接受单纯颅骨修补术的患者进行回顾性研究。为限制混杂因素，排除了接受额外头皮重建或放射学随访时间少于1年的患者。使用计算机断层扫描或磁共振成像在不同时间点测量头皮相同位置及头皮镜像侧的厚度。
确定了101例接受自体骨（n = 38）、聚甲基丙烯酸甲酯（n = 33）和钛网（n = 30）治疗的患者。平均颅骨缺损大小为104.6±43.8 cm。平均随访时间为5.6±2.6年。所有材料上均出现了明显的头皮变薄（<0.05）。这在重建后的头2年最为明显。危险因素包括使用钛网（<0.05）、使用放射治疗（<0.05）、颞部重建（<0.05）以及使用T形或“问号”形切口（<0.05）。
自体材料和异体材料上均出现了天然头皮变薄。使用钛网时，这一过程更严重且进展更快。在我们这组无既往软组织问题的患者中，天然头皮萎缩很少导致植入物外露。头皮萎缩的其他危险因素包括放射治疗、颞部位置和手术切口类型。
