Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Division of Dermatologic Surgery, Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.
J Plast Reconstr Aesthet Surg. 2021 Nov;74(11):3008-3014. doi: 10.1016/j.bjps.2021.03.080. Epub 2021 Apr 23.
Scalp wounds pose reconstructive challenges due to the lack of skin elasticity, potential for compromised adjacent tissue, and desire for the restoration of esthetic contour. Bilayer Wound Matrix (BWM) has been successfully employed as a treatment modality for complex, full-thickness wounds of the scalp. We aimed to highlight risk factors for BWM success and failure in complex wounds of the scalp.
A retrospective case-control study was performed from 2012 to 2019 of adult subjects who presented to plastic or dermatological surgery with complex scalp defects with or without exposed calvarium, who underwent staged reconstruction with BWM and split-thickness skin grafting or secondary intention. Success was defined as complete wound re-epithelialization within 90-day follow-up without additional operative procedures for wound coverage. Demographics, comorbidities, treatment history, wound characteristics, and clinical course were analyzed and correlated with reconstructive outcomes.
In total, 127 subjects were identified for inclusion, with mean age 74.6 ± 12.2 years, defect area 80.2 ± 89.4 cm, and wound age 10.0 ± 65.4 days. Successful wound reconstruction occurred in 107 (84%) subjects. Postoperative wound infections were an independent predictor of BWM failure at 90 days (Odds Ratio: 6.4, 95% Confidence Interval: 1.5 - 26.7, and p<0.012). Additionally, subjects who underwent preoperative radiation were more likely to suffer from reconstructive failure (p<0.040) as well as those who require postoperative inpatient admission (p<0.034).
BWM represents a reliable and efficacious modality in the treatment of complex scalp wounds. Patient comorbidities may not heavily influence the success of BWM to establish adequate wound coverage; however, preoperative radiation and postoperative wound infection may often lead to reconstructive failure.
头皮伤口由于缺乏皮肤弹性、相邻组织受损的可能性以及对美容轮廓恢复的要求，给重建带来了挑战。双层创面基质（BWM）已成功用作头皮全层复杂伤口的治疗方法。我们旨在强调头皮复杂伤口中 BWM 成功和失败的风险因素。
对 2012 年至 2019 年期间因头皮复杂缺损（伴有或不伴有颅骨暴露）而接受分期重建 BWM 和断层皮片移植或二期愈合的成年患者进行回顾性病例对照研究。成功定义为 90 天随访内完全再上皮化，无需进行额外的伤口覆盖手术。分析人口统计学、合并症、治疗史、伤口特征和临床过程，并与重建结果相关联。
共纳入 127 例患者，平均年龄 74.6 ± 12.2 岁，缺损面积 80.2 ± 89.4cm，伤口年龄 10.0 ± 65.4 天。107 例（84%）患者的伤口重建成功。术后伤口感染是 90 天 BWM 失败的独立预测因素（优势比：6.4，95%置信区间：1.5-26.7，p<0.012）。此外，术前接受过放疗的患者更容易发生重建失败（p<0.040），需要术后住院的患者也更容易发生（p<0.034）。
BWM 是治疗复杂头皮伤口的可靠有效的方法。患者的合并症可能不会严重影响 BWM 建立足够的伤口覆盖的成功率；然而，术前放疗和术后伤口感染常常导致重建失败。
