Dowdle Travis S, Chellappan Brinda, Pinto-Cuberos Juan M, Verma Kritin K, Armenta Andrew M, Winsett Frank T, Wagner Richard F
Department of Dermatology, University of Texas Medical Branch, 301 University Boulevard, 4.112, McCullough Building, Galveston, TX, 77555, USA.
Texas Tech University Health Sciences Center-School of Medicine, Lubbock, TX, USA.
Arch Dermatol Res. 2025 Jan 7;317(1):193. doi: 10.1007/s00403-024-03720-8.
Keratinocyte carcinomas (KCs) are commonly located on the scalp and often treated with excision with peripheral and deep en face margin assessment (PDEMA), with Mohs micrographic surgery (MMS) being the most frequently used method. Resection of these malignancies results in wounds with a wide variety of sizes, ranging from small, sub-centimeter defects, to extensive, nearly complete scalp defects. MMS is often the preferred treatment for tumor resection and margin clearance, as it allows for maximal healthy tissue preservation and has the lowest recurrence rates. Multiple local flap reconstruction options exist, and the selection depends on the size and location of the defect. This review highlights the indications, typical locations, potential risks, and advantages of frequently used local flaps on the scalp, accompanied by artistic representations of each flap herein. An exhaustive list of the local scalp flaps discussed in this review includes single, bilateral, and triple rotation flaps, the pinwheel flap, the double hatchet flap, the triple rhomboid flap, both the unilateral and bilateral banner flaps with split thickness skin grafts, A to T flaps, H-plasty flaps, single and double bridge flaps, and the pacman flap. Inelasticity of the scalp inhibits tissue movement so flaps on the scalp must be designed to be much larger than flaps in most other facial locations. One of the greatest benefits of working with local flaps on the scalp is often the presence of hair-bearing skin which provides the reconstructive surgeon the ability to hide significant scars under hair-bearing scalp, and the ability to perform wound repair under local anesthetic immediately following tumor removal by MMS.
角质形成细胞癌（KCs）通常位于头皮，常采用外周和深部垂直切缘评估的切除术（PDEMA）进行治疗，其中莫氏显微外科手术（MMS）是最常用的方法。切除这些恶性肿瘤会导致大小各异的伤口，从小的亚厘米级缺损到广泛的、几乎完全的头皮缺损。MMS通常是肿瘤切除和切缘清除的首选治疗方法，因为它能最大程度地保留健康组织，且复发率最低。存在多种局部皮瓣重建选择，其选择取决于缺损的大小和位置。本综述重点介绍了头皮上常用局部皮瓣的适应症、典型位置、潜在风险和优势，并配有每个皮瓣的示意图。本综述中讨论的局部头皮皮瓣的详尽列表包括单旋转皮瓣、双旋转皮瓣和三旋转皮瓣、风车皮瓣、双斧形皮瓣、三菱形皮瓣、带分层皮片移植的单侧和双侧旗形皮瓣、A至T皮瓣、H形整形皮瓣、单桥和双桥皮瓣以及吃豆人皮瓣。头皮的弹性不足会抑制组织移动，因此头皮上的皮瓣设计必须比大多数其他面部位置的皮瓣大得多。在头皮上使用局部皮瓣的最大好处之一通常是存在有毛发的皮肤，这使重建外科医生能够将明显的疤痕隐藏在有毛发的头皮下，并且能够在通过MMS切除肿瘤后立即在局部麻醉下进行伤口修复。
