Liu Jiaxi, Zhang Juan, Song Baoqiang
Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Shaanxi Xi'an, People's Republic of China.
Facial Plast Surg. 2023 Feb;39(1):63-68. doi: 10.1055/a-1967-8376. Epub 2022 Oct 26.
Although the incidence of scalp avulsion has decreased in recent years, it remains a major concern among plastic surgeons. We therefore aimed to introduce an improved free flap technique for repairing scalp avulsion with less tissue from the donor site. This method can achieve maximum primary closure of the donor site and improve its appearance and function as well as reduce the donor-site morbidity by ensuring that a smaller free flap can completely cover the scalp defect. Eight patients with scalp avulsion who had undergone staggered placement of the free flaps were evaluated. Data on the age, cause of scalp avulsion, scalp defect size, degree of avulsion, postoperative complications, and follow-up duration were analyzed. The postoperative evaluation criteria were donor-site sensation, latissimus dorsi muscle strength, upper extremity function, and quality of life. Patients' mean age was 38.7 years. The main cause of scalp avulsion was occupation-related accidents. The mean scalp defect size and postoperative follow-up duration were 26 cm × 20.4 cm and 41.5 months, respectively. One patient developed flap congestion postoperatively. The wounds at the recipient site healed well in all patients. There was no significant difference in the sensation between the surgical and nonsurgical sides. However, the latissimus dorsi muscle strength significantly differed between both sides. The mental component score, which was used to assess quality of life, did not significantly differ between the patients and healthy population, whereas the physical component score significantly differed between the two groups. None of the included patients had severe upper extremity functional limitation. Staggered placement of free flaps achieved maximum primary closure of the donor site and greater scalp avulsion defect coverage with less tissue excised from the donor site. Importantly, donor-site appearance improved and some donor-site functions were preserved postoperatively.
尽管近年来头皮撕脱伤的发生率有所下降，但它仍是整形外科医生主要关注的问题。因此，我们旨在引入一种改良的游离皮瓣技术，以修复头皮撕脱伤，同时减少供区组织的使用。这种方法可以实现供区的最大一期闭合，改善其外观和功能，并通过确保较小的游离皮瓣能够完全覆盖头皮缺损来降低供区并发症的发生率。对8例行游离皮瓣交错放置修复头皮撕脱伤的患者进行了评估。分析了患者的年龄、头皮撕脱伤的原因、头皮缺损大小、撕脱程度、术后并发症及随访时间等数据。术后评估标准包括供区感觉、背阔肌肌力、上肢功能和生活质量。患者的平均年龄为38.7岁。头皮撕脱伤的主要原因是职业相关事故。头皮缺损的平均大小和术后随访时间分别为26 cm×20.4 cm和41.5个月。1例患者术后出现皮瓣充血。所有患者受区伤口愈合良好。手术侧与非手术侧的感觉无显著差异。然而，两侧背阔肌肌力有显著差异。用于评估生活质量的精神健康评分在患者与健康人群之间无显著差异，而身体功能评分在两组之间有显著差异。纳入的患者均无严重的上肢功能受限。游离皮瓣的交错放置实现了供区的最大一期闭合，用较少的供区组织切除量更大程度地覆盖了头皮撕脱伤缺损。重要的是，术后供区外观得到改善，部分供区功能得以保留。
