Oishi S N, Luce E A
Department of Surgery, University of Kentucky Chandler Medical Center, Lexington, USA.
Clin Plast Surg. 1995 Jan;22(1):51-9.
Scalp and skull defects can be very difficult to reconstruct. Whereas small defects may require only primary closure, skin graft, or small rotation flaps, large defects involving full-thickness scalp can be much more problematic. These large defects may require free-tissue transfer for adequate soft-tissue coverage. The calvaria also may require reconstruction. If the underlying bone is not infected, it can be left in situ and covered with well-vascularized tissue. The bone should be removed only if it is infected. Calvarial reconstruction should then be delayed for 3 to 6 months. If the tissue has been irradiated, only selected defects are appropriate for coverage with local scalp flaps because adjacent tissues may have underlying damage. With a methodic, accurate assessment of the defect, successful reconstruction can be expected.
头皮和颅骨缺损的重建可能非常困难。小的缺损可能仅需一期缝合、植皮或小的旋转皮瓣，而涉及全层头皮的大缺损则问题更多。这些大的缺损可能需要进行游离组织移植以获得足够的软组织覆盖。颅骨也可能需要重建。如果颅骨下方的骨质未受感染，可将其保留原位并用血运丰富的组织覆盖。仅在骨质受感染时才应将其去除。颅骨重建应推迟3至6个月。如果组织已接受过放疗，只有部分选定的缺损适合用局部头皮瓣覆盖，因为相邻组织可能已受到潜在损伤。通过对缺损进行系统、准确的评估，有望实现成功重建。
