Bota Olimpiu, Beyer Franziska, Klein Johann, Juratli Tareq A, Dragu Adrian, Bienger Kevin
Department of Plastic Surgery, First Surgical Clinic, Emergency County Hospital Cluj-Napoca, Iuliu Haţieganu University of Medicine and Pharmacy , Cluj-Napoca, Romania.
University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany.
GMS Interdiscip Plast Reconstr Surg DGPW. 2024 Sep 30;13:Doc05. doi: 10.3205/iprs000187. eCollection 2024.
Scalp defect reconstruction requires interdisciplinary cooperation to restore soft tissue and osseous defects. While wound closure and form restoration, often a short-term treatment goal, ensures patient survival, the long-term preservation of the head and neck's integrity and aesthetics is crucial for maintaining quality of life. This study aims to compare, quantify, and establish a safe and reproducible approach to various reconstruction options and the postoperative complication profile for individual scalp defect areas.
We retrospectively evaluated patients who underwent scalp reconstruction at our institution between March 2017 and April 2022. The inclusion criterion was the presence of a soft tissue defect at the cranium level.
We included 31 patients in the study (17 males, 14 females), with an average age of 61 years (range 17-92 years). Eight patients had received radiotherapy in the affected region. The mean defect size was 72.5±116 cm (range 20-441 cm), and an average of 3±2 surgeries had been performed before the plastic surgical treatment was initiated. Eleven patients had only a soft tissue defect, while 20 patients had an associated bone defect. Fifteen of these patients received a cranioplasty. The rotation flap was the most frequently used (n=23), with or without split-thickness skin grafting, followed by the free latissimus dorsi muscle flap with split-thickness skin grafting (n=5), and the free lateral arm flap (n=2). Revision surgeries were necessary in 38.7% of cases due to wound healing disorders (n=9), bleeding (n=2), and cerebrospinal fluid leaks (n=1). Eventually, all wounds were successfully closed.
Complex scalp defects can be closed using local flaps, thereby restoring aesthetics and tissue integrity. Free flaps remain a reliable solution for extensive defects. Moreover, in cases requiring cranioplasty, careful preoperative planning and an uncontaminated wound are essential for successful treatment.
头皮缺损修复需要多学科协作以恢复软组织和骨组织缺损。伤口闭合和外形修复通常是短期治疗目标，可确保患者存活，但长期保持头颈部的完整性和美观性对于维持生活质量至关重要。本研究旨在比较、量化并建立一种安全且可重复的方法，用于处理各种修复方案以及个体头皮缺损区域的术后并发症情况。
我们回顾性评估了2017年3月至2022年4月期间在我院接受头皮重建的患者。纳入标准为颅骨水平存在软组织缺损。
本研究共纳入31例患者（男性17例，女性14例），平均年龄61岁（范围17 - 92岁）。8例患者在患区接受过放疗。平均缺损面积为72.5±116平方厘米（范围20 - 441平方厘米），在开始整形外科治疗前平均进行了3±2次手术。11例患者仅有软组织缺损，20例患者伴有骨缺损。其中15例患者接受了颅骨成形术。旋转皮瓣是最常用的（n = 23），有或没有断层皮片移植，其次是带断层皮片移植的背阔肌游离皮瓣（n = 5）和上臂外侧游离皮瓣（n = 2）。38.7%的病例因伤口愈合障碍（n = 9）、出血（n = 2）和脑脊液漏（n = 1）需要进行修复手术。最终，所有伤口均成功闭合。
复杂头皮缺损可通过局部皮瓣闭合，从而恢复美观和组织完整性。游离皮瓣仍是大面积缺损的可靠解决方案。此外，在需要颅骨成形术的病例中，仔细的术前规划和无污染的伤口对于成功治疗至关重要。
