Reynoso Rafael, Echeverría Alfonso, Mejia Rivera Samaria Estefania, Villasana Sánchez Jazmín
From the Department of Plastic and Reconstructive Surgery, General Hospital of Mexico, Mexico City, Mexico.
Plast Reconstr Surg Glob Open. 2024 Nov 5;12(11):e6276. doi: 10.1097/GOX.0000000000006276. eCollection 2024 Nov.
Total avulsion of the scalp represents a therapeutic challenge with no consensus nowadays. Currently, microsurgical reimplantation is the reconstructive procedure of choice, but in case it is not feasible, the literature does not define an ideal treatment for an immediate reconstruction. We present the case of an 18-year-old woman with total avulsion of the scalp and forehead skin without possibility of reimplantation. We performed the surgical reconstruction with a latissimus dorsi free flap, and to achieve greater malleability, the flap was harvested without fascia. A large coverage was immediately achieved, and 1 year after the procedure, the patient showed excellent cranial symmetry and a high level of satisfaction. The optimal treatment of total avulsion of the scalp with no option of reimplantation remains a challenge. In our case, the subfascial dissection increased the flap area to cover the defect. Our procedure could be considered as an alternative surgical strategy in flap harvest, but more cases are needed.
头皮完全撕脱是一项目前尚无共识的治疗挑战。目前，显微外科再植是首选的重建手术，但如果不可行，文献中并未明确立即重建的理想治疗方法。我们报告一例18岁女性患者，其头皮和额部皮肤完全撕脱，无法进行再植。我们采用背阔肌游离皮瓣进行手术重建，为获得更大的柔韧性，皮瓣在不携带筋膜的情况下切取。即刻实现了大面积覆盖，术后1年，患者颅骨对称性良好，满意度高。对于无法进行再植的头皮完全撕脱，最佳治疗方法仍然是一项挑战。在我们的病例中，筋膜下剥离增加了皮瓣面积以覆盖缺损。我们的手术方法可被视为皮瓣切取的一种替代手术策略，但还需要更多病例。
