Cheng K, Zhou S, Jiang K, Wang S, Dong J, Huang W, Chang T
Department of Plastic and Reconstructive Surgery, Shanghai Ninth Hospital, People's Republic of China.
Plast Reconstr Surg. 1996 May;97(6):1099-106; discussion 1107-8. doi: 10.1097/00006534-199605000-00001.
Our 4-year experience with 20 patients who had suffered avulsion of 75 percent or more of the scalp is reviewed. All patients underwent replantation using microsurgical technique with 100 percent survival in 16, partial survival in 3, and failure in only 1 case. The emergency management and indications for replantation are demonstrated. The roles of sufficient preoperative preparation, generous debridement of damaged vessels, interpositional vein grafts, and the shortening of operative time in contributing to this success are emphasized. We developed a new surgical procedure called simultaneous vein grafts on donor and recipient sites in an effort to use less time in the anastomosis of interpositional vein grafts. Furthermore, we anastomosed the extra artery of the scalp to the vein on the recipient head when no suitable vein could be found. Intraoperative repair of the scalp sensory nerve and no postoperative use of any vasodilator or anticoagulant are discussed.
回顾了我们对20例头皮撕脱面积达75%及以上患者的4年治疗经验。所有患者均采用显微外科技术进行再植，16例完全存活，3例部分存活，仅1例失败。阐述了再植的急诊处理及适应证。强调了充分的术前准备、对受损血管的广泛清创、静脉移植以及缩短手术时间对取得这一成功的作用。我们开发了一种新的手术方法，即在供体和受体部位同时进行静脉移植，以减少静脉移植吻合的时间。此外，当找不到合适的静脉时，我们将头皮的额外动脉与受体头部的静脉进行吻合。讨论了术中头皮感觉神经的修复以及术后不使用任何血管扩张剂或抗凝剂的情况。
