Martínez Peral Raúl, Roca Mas Josep Oriol, Soroa Moreno Gonzalo Joaquín, Álvarez Río Adela, Ansó Jiménez Antonio, Navarro Sánchez Daniel, Monge Castresana Ivan, Estrada Cuxart Jaime
Department of Plastic & Reconstructive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain.
JPRAS Open. 2024 Nov 17;43:205-215. doi: 10.1016/j.jpra.2024.11.003. eCollection 2025 Mar.
Extensive scalp defects present a significant reconstructive challenge due to the complex needs of patients that are often beyond the scope of conventional therapies, which makes free flaps the most reliable solution. Despite the variety of free flaps available for such cases, there is a lack of clear criteria for selecting the most suitable option. The primary objective of this study was to provide a simplified guide for the selection of donor sites for free flaps for achieving optimal reconstruction outcomes.
A retrospective study was conducted on 15 patients who underwent scalp reconstruction with free flaps between 2017 and 2022: 4 latissimus dorsi (LD), 4 omental (OM), 5 anterolateral thigh (ALT), and 2 radial forearm free (RFF) flaps. Reconstructive and postoperative data for all patients were collected, evaluated, and compared.
The mean defect size to be restored was 110.60 ± 14.55 cm² (LD 162.23 ± 23.1 cm, OM 141.68 ± 11.80 cm, ALT 73.83 ± 14.69 cm, and RFF 37.13 ± 4.88 cm). Seven complications were reported, with partial flap loss being the most common: LD = 2 and OM = 3. Mean healing time of the donor and recipient sites was 2.53 ± 0.27 and 1.8 ± 0.31 months, respectively, with OM having the longest average period for recipient site healing (3.65 ± 0.24 months).
Reconstructing extensive scalp defects requires careful consideration of critical factors such as defect size, donor tissue availability, need for adjuvant therapies, and patient comorbidities when selecting a flap. This underscores the importance of tailored approaches to enhance clinical outcomes. We propose a simplified algorithm for free flap selection to streamline the decision-making process in complex cases.
大面积头皮缺损给重建带来了重大挑战，因为患者的复杂需求往往超出了传统治疗的范围，这使得游离皮瓣成为最可靠的解决方案。尽管有多种游离皮瓣可用于此类病例，但缺乏选择最合适皮瓣的明确标准。本研究的主要目的是提供一个简化的指南，用于选择游离皮瓣的供区，以实现最佳的重建效果。
对2017年至2022年间接受游离皮瓣头皮重建的15例患者进行回顾性研究：4例背阔肌（LD）、4例大网膜（OM）、5例股前外侧（ALT）和2例桡侧前臂游离（RFF）皮瓣。收集、评估并比较所有患者的重建和术后数据。
待修复的平均缺损面积为110.60±14.55平方厘米（LD为162.23±23.1平方厘米，OM为141.68±11.80平方厘米，ALT为73.83±14.69平方厘米，RFF为37.13±4.88平方厘米）。报告了7例并发症，皮瓣部分坏死是最常见的：LD = 2例，OM = 3例。供区和受区的平均愈合时间分别为2.53±0.27个月和1.8±0.31个月，其中OM受区愈合的平均时间最长（3.65±0.24个月）。
重建大面积头皮缺损在选择皮瓣时需要仔细考虑关键因素，如缺损大小、供区组织可用性、辅助治疗需求和患者合并症。这凸显了采用个性化方法以提高临床效果的重要性。我们提出了一种简化的游离皮瓣选择算法，以简化复杂病例的决策过程。
