Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
J Plast Reconstr Aesthet Surg. 2024 Jun;93:18-23. doi: 10.1016/j.bjps.2024.03.009. Epub 2024 Mar 26.
Treatment of scalp malignancies may include the need for craniectomy. The decision to perform cranioplasty is not straightforward and is frequently subjective. The purpose of this study was to assess the clinical outcomes after reconstruction of complex scalp and calvarial defects by comparing patients with and without cranioplasty.
Retrospective review of the clinical records of a consecutive series of patients who underwent scalp soft tissue reconstruction after craniectomy for malignancy or osteoradionecrosis between 2014 and 2022 at Royal Melbourne Hospital was conducted. Demographics, previous treatments, surgical details, and post-operative complications were assessed. Traumatic injuries and decompressive craniectomies were excluded. Minimum follow-up of 6 months.
Thirty-seven patients were included in the study. Indications for surgery included skin malignancies, osteoradionecrosis, or both. There was one reconstructive failure (in the non-cranioplasty group). Infection and metalware exposure were common complications in patients who underwent cranioplasty (38.5%). No patient developed neurological symptoms subsequent to craniectomy. One patient needed revision surgery due to esthetic reasons (cranioplasty group). Transposition flaps were associated with more complications and revision procedures.
Combined scalp and calvarial defects pose a difficult reconstructive challenge. Stable soft tissue coverage is more reliably achieved with free flap reconstruction. Cranioplasty is not always mandatory and should be reserved for cases with a very large bony defect or when the defect is located in a cosmetically sensitive area.
头皮恶性肿瘤的治疗可能需要颅骨切除术。进行颅骨修复术的决定并不简单，而且常常是主观的。本研究的目的是通过比较行颅骨修补术和不行颅骨修补术的患者，评估复杂头皮和颅骨缺损重建后的临床结果。
回顾性分析 2014 年至 2022 年期间在皇家墨尔本医院因恶性肿瘤或放射性骨坏死而行颅骨切除术的连续系列患者的临床记录。评估了患者的人口统计学、既往治疗、手术细节和术后并发症。排除了创伤性损伤和减压性颅骨切除术。随访时间至少 6 个月。
本研究共纳入 37 例患者。手术指征包括皮肤恶性肿瘤、放射性骨坏死或两者兼有。非颅骨修补组有 1 例重建失败。颅骨修补术后感染和金属植入物外露是常见并发症（38.5%）。颅骨切除术后无患者出现神经症状。因美容原因，1 例患者（颅骨修补组）需要再次手术。皮瓣转移与更多的并发症和修复手术有关。
头皮和颅骨联合缺损带来了很大的重建挑战。游离皮瓣重建更可靠地实现稳定的软组织覆盖。颅骨修补术并非总是必需的，应保留用于骨缺损非常大或位于美容敏感区域的病例。
