Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
Department of Health Service Management and Medical Education, School of Military Preventive Medicine, Air Force Medical University, Xi'an, Shaanxi, China.
World Neurosurg. 2024 Jan;181:e252-e260. doi: 10.1016/j.wneu.2023.10.034. Epub 2023 Oct 11.
Treating scalp defects after revascularization surgery is difficult because the scalp microcirculation is severely compromised. We aimed to review the clinical effects of using rotational flaps in scalp defect reconstruction and explore risk factors for wound-related complications (WRC) after reconstruction surgery.
We retrospectively identified patients with scalp defects after combined revascularization surgery who were surgically treated with rotational flap reconstruction at our institution between January 2018 and December 2022. We analyzed treatment results in different surgical technique and revascularization strategy cohorts, including direct bypass superficial temporal artery branch selection, indirect bypass types, and skin incisions.
Eleven patients were included. The superficial temporal artery parietal branch was selected for direct bypass surgery in 10 (90.9%) patients, 4 (40%) of whom had WRC after flap reconstruction. Five types of indirect bypass surgeries were performed; three patients treated by encephalo-duro-myo-arterio-perio-synangiosis and 1 patient treated by encephalo-duro-myo-perio-synangiosis had WRC after flap reconstruction. Question mark (n = 6, 54.5%), curved (n = 4, 36.65%), and Y-shaped (n = 1, 9.1%) incisions were used; in the first three incision cohorts, 2 patients in each cohort had WRC after flap reconstruction.
Patients had the following commonalities that may be risk factors for WRC after flap reconstruction: 1) wounds with nonviable bone exposure after revascularization surgery; 2) three or more tissues used as donor tissues and donor tissues containing the periosteum; and 3) thin scalp around the defect.
头皮再血管化术后出现头皮缺损的治疗较为困难，因为头皮微循环严重受损。我们旨在回顾使用旋转皮瓣重建头皮缺损的临床效果，并探讨重建术后与伤口相关并发症（WRC）的相关风险因素。
我们回顾性分析了 2018 年 1 月至 2022 年 12 月期间在我院因联合再血管化术后出现头皮缺损而接受旋转皮瓣重建手术的患者。我们分析了不同手术技术和再血管化策略组的治疗结果，包括直接旁路颞浅动脉支选择、间接旁路类型和皮肤切口。
11 例患者入组。10 例（90.9%）患者选择颞浅动脉顶支进行直接旁路手术，其中 4 例（40%）在皮瓣重建后出现 WRC。共进行了 5 种间接旁路手术；3 例患者行脑-硬脑膜-肌肉-动脉-血管周-吻合术，1 例患者行脑-硬脑膜-肌肉-血管周-吻合术，在皮瓣重建后均出现 WRC。问号（n=6，54.5%）、弯曲（n=4，36.65%）和 Y 形（n=1，9.1%）切口；在前三个切口组中，每个切口组均有 2 例患者在皮瓣重建后出现 WRC。
患者可能存在以下共性，这些共性可能是皮瓣重建后出现 WRC 的风险因素：1）再血管化术后有无法存活的骨暴露的伤口；2）使用了三种或更多的组织作为供体组织，且供体组织含有骨膜；3）缺损周围的头皮较薄。
