Maus Jacob C, Hemal Kshipra, Khan Mija, Calder Bennett W, Marks Malcolm W, Defranzo Anthony J, Pestana Ivo Alexander
Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Otolaryngol Head Neck Surg. 2021 Aug;165(2):275-281. doi: 10.1177/0194599820986582. Epub 2021 Feb 16.
Dermal regeneration template and staged split-thickness skin grafting may mitigate the need for flap coverage of postoncologic scalp defects. This technique has been studied previously in small case series. We examine the effect of risk factors, surgical technique, irradiation, and dressing modalities on reconstructive outcomes in a highly comorbid patient cohort.
Retrospective review.
Academic medical center.
Full- and partial-thickness extirpative scalp wounds reconstructed with dermal regeneration template and staged skin grafting were reviewed over a 14-year period. Stage 1 consisted of template application following burr craniectomy in cases lacking periosteum. Stage 2 consisted of skin grafting. Negative pressure wound therapy (NPWT) was variably used to support adherence.
In total, 102 patients were analyzed (average age 74, mean follow-up 18 months). Eighty-one percent were American Society of Anesthesiologists class 3 or 4. Defect size averaged 56 cm. Average skin graft take was 94.5% in full-thickness wounds. Seven patients failed this method. Preoperative scalp irradiation was associated with major complication and delayed graft healing. Comorbidities, wound size, and burring were not associated with complication. Patients were more likely to heal with NPWT compared to bolster (hazard ratio, 1.67; 95% CI 1.01-2.77; = .046). Time between stages was 6.6 days shorter when NPWT was applied ( < .001).
Dermal template and staged skin grafting is a reliable option for postcancer scalp reconstruction in poor flap candidates. Radiotherapy is associated with adverse outcomes. Negative pressure wound therapy simplifies postoperative wound care regimens and may accelerate healing.
真皮再生模板和分期断层皮片移植可减少肿瘤切除术后头皮缺损皮瓣覆盖的需求。该技术此前已在小病例系列中进行过研究。我们研究了危险因素、手术技术、放疗和敷料方式对高度合并症患者队列重建结果的影响。
回顾性研究。
学术医疗中心。
回顾了14年间采用真皮再生模板和分期皮片移植重建的全层和部分厚度切除性头皮伤口。第1阶段包括在缺乏骨膜的病例中，在颅骨钻孔切除术后应用模板。第2阶段包括皮片移植。负压伤口治疗（NPWT）被不同程度地用于促进粘连。
共分析了102例患者（平均年龄74岁，平均随访18个月）。81%为美国麻醉医师协会3或4级。缺损大小平均为56平方厘米。全层伤口的平均皮片成活率为94.5%。7例患者该方法失败。术前头皮放疗与主要并发症和移植愈合延迟相关。合并症、伤口大小和颅骨钻孔与并发症无关。与使用支撑物相比，使用NPWT的患者愈合可能性更大（风险比，1.67；95%置信区间1.01 - 2.77；P = .046）。应用NPWT时，两阶段之间的时间缩短了6.6天（P < .001）。
对于皮瓣修复条件较差的癌症后头皮重建，真皮模板和分期皮片移植是一种可靠的选择。放疗与不良结局相关。负压伤口治疗简化了术后伤口护理方案，并可能加速愈合。
