Onishi K, Maruyama Y, Sawaizumi M, Iwahira Y, Seiki Y
Department of Plastic and Reconstructive Surgery, Toho University Hospital, Tokyo, Japan.
No Shinkei Geka. 1997 Sep;25(9):795-800.
The size of detects in scalp for which primary wound closure can be applied is limited. Cases with a scalp defect for which primary wound closure is difficult to perform are frequently seen. In these cases, an attempt is made to close the wound by extending the margin of an incision produced by extensive subgaleal undermining or galeal incisions. However, its effectiveness is limited. We performed in such cases intra-operative scalp expansion with a tissue expander for primary wound closure, and this technique has yielded good results. A case with craniosynostosis and five cases with cranioplasty received this procedure. Four of these cases had a previous history of undergoing surgery for carvarial bone defect three to five times from the same incision. The scalp at the carvarial bone defect had a scar and was atrophic with great depression. It was expected that the expansion of cranium resulting from cranioplasty would make it difficult to perform primary wound closure. During the surgery, a tissue expander was placed subgaleally in an osseous area prior to the bone operation, and intermittent air expansion was carried out for 20 to 30 minutes by means of air inflation and deflation to expand the scalp. In all of these cases little tension was generated by the wound closure despite the lapse of time during the bone operation. In consequence, primary wound closure was accomplished easily, and the reliable closure of the galea made it possible to prevent the scar widening. This is a simple and easy technique combining primary wound closure of the scalp with intra-operative scalp expansion. We believe that the technique should be considered for cases for whom primary closure of compression deformity is difficult or in whom there is a wound at the carvarial reconstruction site. The technique and typical cases are reported.
能够进行一期伤口缝合的头皮缺损大小有限。经常会遇到难以进行一期伤口缝合的头皮缺损病例。在这些情况下，人们试图通过扩大广泛帽状腱膜下潜行分离或帽状腱膜切开所产生的切口边缘来闭合伤口。然而，其效果有限。我们在这类病例中使用组织扩张器进行术中头皮扩张以实现一期伤口缝合，该技术取得了良好效果。1例颅缝早闭患者和5例颅骨成形术患者接受了此手术。其中4例患者曾有过同一切口处颅骨骨缺损手术史三至五次。颅骨骨缺损处的头皮有瘢痕且萎缩凹陷严重。预计颅骨成形术导致的颅骨扩张会使一期伤口缝合难以进行。手术过程中，在骨操作前将组织扩张器置于帽状腱膜下的骨性区域，通过充气和放气进行20至30分钟的间歇性空气扩张以扩张头皮。在所有这些病例中，尽管骨操作过程耗时，但伤口缝合时产生的张力很小。因此，一期伤口缝合轻松完成，可靠的帽状腱膜闭合使得防止瘢痕增宽成为可能。这是一种将头皮一期伤口缝合与术中头皮扩张相结合的简单易行的技术。我们认为，对于难以进行一期压迫畸形闭合的病例或颅骨重建部位有伤口的病例，应考虑采用该技术。本文报道了该技术及典型病例。
