Nassar Aref, Abou Zeid Samer, El Feghaly Charbel, Kassouf Elia, Naba Joy, Nasr Marwan, Sleilati Fadi
From the Plastic Surgery Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon.
Dermatology Department, Hotel Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon.
Plast Reconstr Surg Glob Open. 2024 Oct 23;12(10):e6259. doi: 10.1097/GOX.0000000000006259. eCollection 2024 Oct.
Large scalp and calvarial defects pose significant challenges for reconstruction. Successful reconstruction necessitates soft tissue restoration capable of withstanding radiation following tumor resection. Free flaps allow preserving and maintaining the structural and functional status of the reconstructed area. This article presents our experience with microsurgical free tissue transfer for scalp and calvarial defects as well as a literature review on the subject.
A retrospective study was conducted to retrieve the files of all the extensive scalp/forehead defects with dural exposure treated in the plastic surgery department of Hotel Dieu de France University Hospital from September 2006 to December 2023.
Twelve free tissue transfers were performed in 11 patients between 2006 and 2023. In 3 cases, a 2-stage procedure was performed with the transfer of the free flap in the first stage and the ablative surgery in the second stage 1 week later. A muscular latissimus dorsi flap was used in 9 cases. In 3 patients, the defect involved the forehead and required cutaneous flaps: 2 radial forearm flaps and 1 parascapular flap. Complications included 1 flap venous thrombosis, 2 hematomas, 1 subdural hematoma, and 2 cases of distal flap necrosis.
Free tissue transfer is indispensable for addressing large defects of the scalp and calvaria. A 2-stage operation is warranted for debilitated patients with a high risk of complications. The latissimus dorsi muscle flap is the flap of choice to cover extensive defects. Delayed cranioplasty is preferable in contaminated wounds.
大面积头皮和颅骨缺损的修复面临重大挑战。成功修复需要能够承受肿瘤切除后放疗的软组织修复。游离皮瓣有助于保留和维持重建区域的结构和功能状态。本文介绍了我们在头皮和颅骨缺损显微外科游离组织移植方面的经验以及关于该主题的文献综述。
进行一项回顾性研究，以检索2006年9月至2023年12月在法国迪厄医院大学医院整形外科接受治疗的所有伴有硬脑膜暴露的广泛性头皮/前额缺损患者的病历。
2006年至2023年期间，11例患者接受了12次游离组织移植。3例患者分两阶段进行手术，第一阶段移植游离皮瓣，1周后在第二阶段进行切除手术。9例患者使用了背阔肌肌皮瓣。3例患者的缺损累及前额，需要皮瓣修复：2例采用桡侧前臂皮瓣，1例采用肩胛旁皮瓣。并发症包括1例皮瓣静脉血栓形成、2例血肿、1例硬脑膜下血肿和2例皮瓣远端坏死。
游离组织移植对于解决头皮和颅骨的大面积缺损必不可少。对于并发症风险高的体弱患者，两阶段手术是必要的。背阔肌肌皮瓣是覆盖大面积缺损的首选皮瓣。对于污染伤口，延期颅骨成形术更为可取。
