Cranial-bone defects with depression deformity treated with ceramic implants and free-flap transfers.
Cranial-bone defects with depression deformity treated with ceramic implants and free-flap transfers.
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通过陶瓷植入物和游离皮瓣转移治疗伴有凹陷畸形的颅骨缺损。
DOI：
10.1054/bjps.2001.3613
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
M. Okada
中科院分区：
文献类型：
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作者：
K. Ueda;S. Oba;Y. Omiya;M. Okada
羟基磷灰石陶瓷在颅骨缺损的修复中具有许多优点。然而，对于伴有严重凹陷畸形的大型颅骨缺损，使用陶瓷植入物可能存在风险，因为会留下硬膜外死腔，并且必须在张力下闭合覆盖的头皮。在这些情况下，微血管游离皮瓣转移是一个很好的解决方案。我们治疗了三个病人，他们因多次局部感染和多次手术或放疗而造成巨大的颅骨缺损并伴有严重的凹陷畸形。第一个病人用背阔肌肌皮瓣和前锯肌肌皮瓣联合填充陶瓷植入物下的硬膜外间隙。在第二例患者中，在辐照部位的陶瓷植入物下方插入背阔肌肌瓣，并使用组合的小前锯肌肌瓣作为监测器。第三位病患则以背阔肌肌皮瓣覆盖陶瓷植体并填补头皮缺损。随访时间为12 ~ 35个月（平均20.7个月）。所有三名患者的临床过程是顺利的，没有皮瓣丢失。通过使陶瓷植入物稍微变平或变厚，可以在一定程度上减少硬膜外间隙，但对于严重凹陷畸形的患者，其脑扩张无法预期，应将肌瓣转移到该间隙中。
Hydroxyapatite ceramic has many advantages in the treatment of cranial-bone defects. However, for large skull defects with severe depression deformities, it may be risky to use ceramic implants because an extradural dead space will be left and the overlying scalp will have to be closed under tension. In these cases microvascular free-flap transfers are a good solution. We have treated three patients for large skull defects with severe depression deformities after repeated local infections and several operations or irradiation. A latissimus dorsi myocutaneous flap was combined with a serratus anterior muscle flap to fill the extradural space under the ceramic implant in the first patient. A latissimus dorsi muscle flap was inserted under the ceramic implant in an irradiated site and a combined small serratus anterior muscle flap was used as a monitor in the second patient. A latissimus dorsi myocutaneous flap was used to cover the ceramic implant and fill the scalp defect in the third patient. The follow-up periods varied from 12 to 35 months (mean: 20.7 months). The clinical courses of all three patients were uneventful and no flap was lost. The extradural space can be reduced to some extent by making the ceramic implant slightly flatter or thicker, but in patients with severe depression deformities, whose brain expansion cannot be expected, a muscle flap should be transferred into the space.