Lessons Learned Reconstructing Complex Scalp Defects Using Free Flaps and a Cranioplasty in One Stage
Lessons Learned Reconstructing Complex Scalp Defects Using Free Flaps and a Cranioplasty in One Stage
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DOI：
10.1097/scs.0b013e3181e17c1e
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发表时间：
2010-07-01
影响因子：
0.9
通讯作者：
Zins, James E.
中科院分区：
文献类型：
--
作者：
Afifi, Ahmed M.;Djohan, Risal S.;Zins, James E.
背景：本研究的目的是回顾我们在单期颅骨和头皮缺损重建中的经验，旨在强调我们在处理中的缺陷。方法：我们对过去10年在我所接受单期颅骨成形术和游离组织移植的所有患者进行了回顾性图表回顾。13例患者(男9例，女4例)，年龄34-83岁，平均66.5岁。其中恶性肿瘤7例，放射性骨坏死3例，感染3例。骨缺损面积12~300cm2，平均103.1 cm(2)。颅骨成形术包括甲基丙烯酸甲酯加钛网片(n-10)、甲基丙烯酸甲酯(n-1)或仅网片(n=2)。采用股前外侧皮瓣10例，背阔肌2例，直肌瓣1例。结果：5例(38%)术后出现至少1例并发症。包括2例成功抢救的吻合口问题，5例伤口裂开，1例因呼吸道事件死亡。4名患者出现复发，2名患者在第二阶段需要进行皮瓣成形。结论：考虑到这些手术的复杂性、复发率和并发症的可能性，甲基丙烯酸甲酯在高危患者的一期颅骨成形术和软组织重建中是禁忌的。对于不利的局部条件(如既往感染、放射治疗)，外科医生可以推迟颅骨成形术，直到软组织重建愈合，或者只使用非解剖钛网。软组织瓣的切取范围应该比预期的要大。
Background: The purpose of this study was to review our experience in single-stage reconstruction of skull and scalp defects, aiming to highlight pitfalls in our management.Methods: We performed a retrospective chart review of all patients who had a single-stage cranioplasty and free-tissue transfer at our institution over the last 10 years. Thirteen patients (9 men and 4 women) with an average age of 66.5 years (range, 34-83 years) were identified. Etiology of the defects included malignancy (n = 7), osteoradionecrosis (n = 3), and infection (n = 3). The size of the bony defect averaged 103.1 cm(2) (range, 12-300 cm(2)). Cranioplasty procedures included reconstruction by methylmethacrylate and titanium mesh (n - 10), methylmethacrylate only (n - 1), or mesh only (n = 2). Free flaps used were anterolateral thigh (n = 10), latissimus dorsi (n = 2), or a rectus flap (n = 1).Results: Five patients (38%) developed at least 1 complication. These included 2 anastomotic problems that were successfully salvaged, 5 cases of wound dehiscence, and 1 mortality due to a respiratory event. Four patients developed a recurrence, and 2 patients required flap contouring at a second stage. Two patients had further reconstruction using 1 (1 patient) or 2 (1 patient) additional free flaps.Conclusions: Given the complexity of these procedures, the high recurrence rate, and the likelihood of complications, methylmethacrylate is contraindicated in 1-stage cranioplasty and soft-tissue reconstruction in high-risk patients. For unfavorable local conditions (eg previous infection, radiotherapy), the surgeon can either postpone the cranioplasty until the soft-tissue reconstruction has healed, or use a nonanatomical titanium mesh alone. The soft-tissue flap should be harvested of larger dimensions than anticipated.