Gyger D, Genin B, Bugmann P, Lironi A, Coultre C L
Hôpital des Enfants Clinique de Chirurgie Pédiatrique, Genève, Suisse.
Eur J Pediatr Surg. 1996 Jun;6(3):166-9. doi: 10.1055/s-2008-1066498.
Since 1990 we have used systematically the scalp as donor site for split skin graft in children. The aim of this retrospective and prospective study is to analyse the results, advantages, disadvantages, complications and problems of this method.
The series includes 43 children, age: 9 months to 15 years 6 months (mean age 5 years 9 months) who presented burns or other lesions. The surface to be grafted was 0.5% to 35% of the body surface (mean surface: 6.6% TBS). The follow-up was 25 to 1086 days (mean: 304 days). The donor site is prepared by marking of the hair-limit, shaving, disinfection and infiltration with normal saline under the galea of the surface to be harvested. Skin harvesting is done with an electrical dermatome. The donor site is covered with sponges soaked in adrenaline (1/500,000).
1 child required harvesting twice in 2 weeks, another one 3 times in 3 months. All the other children required only one procedure. 4 children needed a meshing of the graft. They required also harvesting from other donor sites. The surface to be grafted represented more than 15% TBS. 5 children with a surface to be grafted between 10 and 15% TBS could be covered in one session, without meshing, taking only the scalp. The healing of the scalp was complete after 7 to 14 days (mean: 9.5 days). There was no mortality in our series. We were not confronted with any infection. No hypertrophic scars or retractions were encountered. 3 children presented zones of alopecia, one had sequelae and needed two surgical procedures. The two other cases were minor cases and did not require further treatment. A certain sparseness of hair was noticed in a black girl, after the third harvesting. The blood losses were estimated as a total and have also to be attributed to the tangential excision of the burn area.
Skin harvesting from the scalp in children can be recommended as first choice. The advantages, especially the rapid epithelialisation and the lack of visible scars, overcome the problems and the risks.
自1990年以来，我们系统地将头皮作为儿童中厚皮片移植的供皮区。这项回顾性和前瞻性研究的目的是分析该方法的结果、优点、缺点、并发症及问题。
该系列包括43名儿童，年龄从9个月至15岁6个月（平均年龄5岁9个月），他们均有烧伤或其他损伤。需移植的面积占体表面积的0.5%至35%（平均面积：6.6%TBS）。随访时间为25至1086天（平均：304天）。供皮区的准备包括标记发际线、剃毛、消毒以及在拟取皮表面的帽状腱膜下用生理盐水浸润。用电动取皮刀取皮。供皮区用浸有肾上腺素（1/500,000）的海绵覆盖。
1名儿童在2周内需要取皮2次，另1名儿童在3个月内需要取皮3次。所有其他儿童仅需进行一次手术。4名儿童的移植皮片需要网状植皮。他们还需要从其他供皮区取皮。需移植的面积超过15%TBS。5名需移植面积在10%至15%TBS之间的儿童，仅取头皮一次即可覆盖，无需网状植皮。头皮在7至14天（平均：9.5天）后完全愈合。本系列中无死亡病例。我们未遇到任何感染情况。未出现增生性瘢痕或挛缩。3名儿童出现脱发区；1名有后遗症，需要进行两次外科手术。另外两例情况较轻，无需进一步治疗。一名黑人女孩在第三次取皮后出现一定程度的头发稀疏。失血总量估计也归因于烧伤区的削痂。
儿童头皮取皮可作为首选方法推荐。其优点，尤其是快速上皮化和无明显瘢痕，克服了相关问题及风险。
