Lange-Ionescu S, Frosch P J
Kliniken, Dortmund, Lehrstuhl Dermatologie, Universität Witten/Herdecke.
Hautarzt. 1998 Jul;49(7):556-9. doi: 10.1007/s001050050788.
The closure of large circular defects on the scalp is technically difficult and cosmetically often not satisfying, if a free transplant is necessary. Following the technique of Tillmann described first in 1908, several flaps shaped like a windmill can be combined. We report on 14 patients (ages 41-88 years) where large defects resulting from the excision of various tumors (5 melanomas, 5 basal cell carcinomas, 1 keratoacanthoma, 1 trichilemmal cyst, 1 squamous cell carcinoma, 1 skin metastasis) were successfully closed by this method. The diameter of the defect ranged between 4 and 8 cm (mean 5.7 cm). Size and number of the rotating flaps (3 or 4) was varied according to the size of the defect and the mobility of the surrounding tissue. The procedure was performed with local anesthesia in all cases. Wound healing occurred without complications except in 3 cases. 2 patients (63 years, 70 years) developed small necrotic areas on the tips of the flaps. In a 74 year old man with a very large defect of 8 cm diameter, one flap of four underwent total necrosis. The cosmetic result was rated "very good" in 71.4% and "good" in 14.3%. The preservation of the terminal hair turned out to be of special advantage. The "windmill procedure" is an important addition to the surgical approaches for closure of large defects on the scalp, particularly in young patients.
如果需要进行游离移植，闭合头皮上的大型圆形缺损在技术上具有难度，而且在美容效果上往往不尽人意。遵循1908年首次描述的蒂尔曼技术，可以将几个风车形状的皮瓣组合起来。我们报告了14例患者（年龄在41至88岁之间），他们因切除各种肿瘤（5例黑色素瘤、5例基底细胞癌、1例角化棘皮瘤、1例毛囊囊肿、1例鳞状细胞癌、1例皮肤转移瘤）而导致大型缺损，通过这种方法成功闭合。缺损直径在4至8厘米之间（平均5.7厘米）。旋转皮瓣的大小和数量（3个或4个）根据缺损大小和周围组织的活动度而有所不同。所有病例均在局部麻醉下进行手术。除3例外，伤口愈合均无并发症。2例患者（63岁、70岁）皮瓣尖端出现小面积坏死。一名74岁男性有直径达8厘米的非常大的缺损，四个皮瓣中有一个完全坏死。美容效果评定为“非常好”的占71.4%，“好”的占14.3%。结果表明保留终毛具有特别的优势。“风车手术”是头皮大型缺损闭合手术方法的一项重要补充，尤其对于年轻患者。
