Othman Sammy, Shakir Sameer, Azoury Saïd C, Lukowiak Tess, Shin Thuzar M, Sobanko Joseph F, Miller Christopher J, Etzkorn Jeremy R, Fischer John P, Kovach Stephen J
From the Division of Plastic Surgery, Department of Surgery, and Division of Dermatologic Surgery, Department of Dermatology, University of Pennsylvania.
Plast Reconstr Surg. 2022 Feb 1;149(2):469-480. doi: 10.1097/PRS.0000000000008774.
Local tissue rearrangement, free flap reconstruction, and Bilayer Wound Matrix represent reconstructive modalities for coverage of scalp defects; however, preferred indications are less clear. The authors aimed to evaluate the efficacy of these interventions.
A retrospective review (2008 to 2019) was performed of subjects requiring soft-tissue reconstruction of oncologic scalp wounds. Subjects were dual matched into two comparative cohorts: (1) local tissue rearrangement versus Bilayer Wound Matrix, and (2) free flap reconstruction versus Bilayer Wound Matrix. Ninety-day wound coverage, hospital length of stay, operative time, and wound complications were compared.
In total, 361 subjects were included. Following matching, 126 subjects constituted the local tissue rearrangement versus Bilayer Wound Matrix cohort, and 56 constituted the free flap reconstruction versus Bilayer Wound Matrix cohort. Local tissue rearrangement/Bilayer Wound Matrix median defect size was 35 ± 42.5 cm2. Local tissue rearrangement provided significantly better wound coverage at 90 days (95.2 percent) compared to Bilayer Wound Matrix (84.1 percent) (p < 0.040). Median defect size in the free flap reconstruction/Bilayer Wound Matrix cohort was 100 ± 101.1 cm2. Ninety-day success (free flap reconstruction, 92.9 percent; Bilayer Wound Matrix, 96.4 percent; p < 1.00) and reoperation rates (14.3 percent versus 3.6 percent; p < 0.352) were similar. However, free flap reconstruction had significantly greater operative times (418 minutes versus 100 minutes; p < 0.001).
Local tissue rearrangement may be more reliable for smaller wounds (<100 cm2) compared to Bilayer Wound Matrix. Bilayer Wound Matrix may have comparable efficacy to free flap reconstruction for larger defects (150 to 250 cm2), and may be more cost-effective, given greater operative time and length of stay associated with free flap reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
局部组织重排、游离皮瓣重建和双层伤口基质是覆盖头皮缺损的重建方式；然而，首选适应症尚不清楚。作者旨在评估这些干预措施的疗效。
对2008年至2019年期间需要对肿瘤性头皮伤口进行软组织重建的受试者进行回顾性研究。受试者被双重匹配到两个比较队列中：（1）局部组织重排与双层伤口基质，以及（2）游离皮瓣重建与双层伤口基质。比较了90天伤口覆盖率、住院时间、手术时间和伤口并发症。
总共纳入了361名受试者。匹配后，126名受试者构成局部组织重排与双层伤口基质队列，56名受试者构成游离皮瓣重建与双层伤口基质队列。局部组织重排/双层伤口基质的中位缺损面积为35±42.5平方厘米。与双层伤口基质（84.1%）相比，局部组织重排在90天时提供了显著更好的伤口覆盖率（95.2%）（p<0.040）。游离皮瓣重建/双层伤口基质队列的中位缺损面积为100±101.1平方厘米。90天成功率（游离皮瓣重建，92.9%；双层伤口基质，96.4%；p<1.00）和再次手术率（14.3%对3.6%；p<0.352）相似。然而，游离皮瓣重建的手术时间明显更长（418分钟对100分钟；p<0.001）。
与双层伤口基质相比，局部组织重排在较小伤口（<100平方厘米）的情况下可能更可靠。对于较大缺损（150至250平方厘米），双层伤口基质可能与游离皮瓣重建具有相当的疗效，并且鉴于游离皮瓣重建相关的手术时间和住院时间更长，可能更具成本效益。
临床问题/证据水平：治疗性，III级。
