Free scapular flaps become a choice for repairing large-area scalp defect and skull exposure

doi:10.3969/j.issn.2095-4344.2014.51.022

Abstract

Abstract:

BACKGROUND: The local flap and expanded flap cannot repair the large area scalp defect, especially for patients with skull exposure and infection. The free flap is suitable for this kind of cases. The free scapular flap shows many advantages: constant vessel site, stable blood supply, supporting the amount and variability of tissue types available for harvest and minor deformity of the donor site. It is one of the most excellent choices for large-area scalp defects and skull exposure.
OBJECTIVE: To retrospectively analyze the method and experience of repairing the large area scalp defect and skull exposure by free scapular flaps.
METHODS: Free scapular flaps were used to repair the large-area scalp defects and skull exposure in eight patients. The circumflex scapular vessel was anastomosed with superficial temporal vessel or facial vessel. The patients were followed up for 6-12 months to observe the postoperative conditions of free scapular flaps, such as infection, flap survival, donor site treatment, wound healing and adverse reactions.
RESULTS AND CONCLUSION: All the free scapular flaps survived well in eight cases. The venous stagnation of flap happened in two cases. After punching the flap or removing the suture in the distal end of flaps, the blood supply was improved. During the 1-year follow-up, the blood supply of free scapular flaps and the shape of head were satisfactory. There was no postoperative complication. These findings indicate that the free scapular flap characterized as constant vessel site, stable blood supply, supporting the amount and variability of tissue types available for harvest and minor deformity of the donor site is one of the most excellent choices for repair of large area scalp defects and skull exposure.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: shoulder, surgical flaps, transplants, scalp

CLC Number:

R318

Bao Shi-wei, Ma Xiao-bing, Zhao Hong-yi, Qian Wen-jiang, Yang Ming-yong. Free scapular flaps become a choice for repairing large-area scalp defect and skull exposure[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(51): 8315-8319.

Figures/Tables 2

References

[1]张诚,刘毅,刘萍,等.皮肤软组织扩张术美容修复烧伤后头皮缺损合并颅骨外露[J].中国美容医学,2009,18(12):1717-1719.
[2]毛远桂,熊宏兰,张志安,等.大面积头皮缺损并颅骨外露的治疗[J].江西医学院学报,2006,46(4):78-79.
[3]Fischer JP,Sieber B,Nelson JA,et al．A 15-year experience of complex scalp reconstruction using free tissue transfer-analysis of risk factors for complications. Reconstr Microsurg.2013;29(2):89-97.
[4]李岩,张志华,孔祥红,等. 头皮缺损颅骨失骨膜外露的修复方法探讨[J].中华整形外科杂志,2008,24 (1):77.
[5]袁好军,安静,孙宇航,等.帽状腱膜下筋膜瓣加植皮Ⅰ期修复头皮大面积缺损伴颅骨外露[J].中国美容医学,2014,23(7):526-528.
[6]马显杰,郑岩,夏文森,等.软组织扩张术治疗大面积头面部瘢痕[J].中华整形外科杂志,2008,24(6):447-449.
[7]Gundeslioglu AO,Selimoglu MN,Doldurucu T,et al．Reconstruction of large anterior scalp defects using advancement flaps.J Craniofac Surg.2012;23(6):1766-1769.
[8]姜平,刘晓军,罗勇,等.头皮扩张皮瓣移植分期修复跨发际的头面部大面积缺损[J].中华显微外科杂志,2012,35 (1):64-65.
[9]王明刚,汪洪源,水庆付,等.头皮巨大肿瘤的外科修复与重建[J].安徽医学,2008,29(3):227.
[10]李晓静,宁金龙,高学宏,等.大面积头皮缺损及颅骨外露的显微外科修复[J].中华显微外科杂志,2004,27:30-31.
[11]Gundeslioglu O,Altundag O,Allundag K,et al..Closure of large scalp defects by modified gilles triple scalp in patients with scalp tumors. Plast Reconstr Surg.2005;116:1813-1814.
[12]汪洪源,王明刚,杜晓扬,等. 改进的游离背阔肌皮瓣修复巨大头皮恶性肿瘤切除后软组织缺损[J].安徽医学,2010,31(12): 1432-1434.
[13]吴琳,宋良玉,康久杰.头皮缺损修复方法的选择与探讨[J].中华整形外科杂志,2002,18(2):125-126.
[14]徐路生,郭凡,杜学亮,等.游离串联皮瓣修复颅骨外露头皮缺损的应用[J].岭南现代临床外科,2013,13(6):500-502.
[15]汤海萍,滕国栋,姜凯. 游离皮瓣在颅骨外露的头皮缺损中的应用[J].中国美容医学,2013,2(4):431-433.
[16]刘强,张正之,韩西城.游离大网膜移植治疗烧伤后颅骨缺损五例[J].中华整形烧伤外科杂志,1995,11(2):8.
[17]黄运严,谭海涛,覃秋海,等.应用游离股前外侧皮瓣修复头面部软组织缺损15例报告[J].广西医学,2009,31(7):1048-1049.
[18]王炜,李华.游离股前外侧皮瓣一期修复头皮鳞状细胞癌术后大面积缺损[J].实用医学杂志,2011,27(21):3984-3985.
[19]纪影畅,蔡湘娜,许宏权,等.以皮肤软组织扩张术为主的联合方案修复头面部大面积瘢痕畸形[J].中国美容整形外科杂志,2012, 23(1):41-44.
[20]刘柳,杨磊,赵明朝,等.游离股前外侧穿支皮瓣穿支血管的临床分类及意义[J].中华整形外科杂志,2012,28(4):291-293.
[21]黎洪棉,高建华,姜平,等.头面部皮肤恶性肿瘤手术切除后的整复治疗与评价[J].中国美容整形外科杂志,2010,21:220-222.
[22]洪小芳,孟宏,黄建华,等.游离股前外侧穿支皮瓣在头皮缺损中的应用[J].岭南现代临床外科,14(2):165-167.
[23]屈志刚,刘育杰,丁小珩,等. 应用游离胫后动脉穿支皮瓣修复头皮大面积皮肤缺损[J].中国修复重建外科杂志,2011,25(9): 1147-1148.
[24]Gilbert A,Teot L.The free scapular flap.Plast Reconstr Surg. 1982;69:601-604.
[25]李养群,徐军,李森恺,等.肩胛游离皮瓣修复面颈部皮肤缺损[J].中国修复重建外科杂志,2000,14(4):205-206.
[26]吴晓明,孙奎,耿琪英,等.带血管蒂肩胛游离皮瓣修复创伤后颅面缺损[J].创伤外科杂志,2008,10(3):219-221.
[27]鲍世威,杨明勇,李森恺,等.肩胛游离皮瓣修复大面积难愈性骨外露创面[J].中华整形外科杂志,2008,24(2):160-161.
[28]杨明勇,李式瀛,李森恺,等.旋肩胛动脉升支的解剖学研究[J].中华烧伤整形外科杂志,1996,12(4):293-295.
[29]李养群,李森恺,杨明勇,等.横过中线的肩胛游离皮瓣移植[J].中华烧伤整形外科杂志,1999,15(4):257-258.
[30]Saijo M.The vascular territories of the dorsal trunk:A reappraisal for potential flap donor sites.Br J Plast Surg. 1978; 31:200-208.
[31]唐欣,马婷婷,秦永平,等.游离肩胛区骨皮瓣在舌和口底及下颌骨联合缺损修复中的应用[J].中国美容医学,2009,18(3):315-317.
[32]Saijo M.The vascular territories of the dorsal trunk:A reappraisal for potential flap donor sites.Br J Plast Surg. 1978; 31:200-208.
[33]焦鹏,刘元波,战秋衡,等. 预扩张肩胛皮瓣在胸部瘢痕修复中的应用[J].中国美容医学,2009,18(3):754-756.
[34]刘祥厦,唐庆,曾瑞曦,等.大面积头皮缺损修复的探讨[J].中华损伤与修复杂志:电子版,2013,8(3):283-285.
[35]蔡宝仁,许辉,傅国友,等.肩胛下血管蒂组织瓣的解剖及其临床应用.解剖学研究,2001,23:9-10.
[36]霍然,李森恺,李养群,等.跨越人体中线肩胛皮瓣的微血管造影研究[J].中华整形外科杂志,2004,20(4):262-264.
[37]雷少榕,黄晓元,龙剑虹,等.游离肩胛皮瓣修复足部皮肤软组织缺损疗效评价[J].中国医学工程,2004,12(5):76-77.
[38]Kawamura K, Yajima H, Kobata Y, et al. Anatomy of Y-Shaped configurations in the subscapular arterial system and clinical application to harvest in flow-through flaps.Plast Reconstr Surg. 2005;116(4): 1082-1089.
[39]关志广,梁耀婵,张志平,等.肩胛游离皮瓣修复面部皮肤软组织缺损.中国美容医学,2004,13:39-40.
[40]Zumiotti AV,Teng Hw,Ferreira Mc.Treatment of post-traumatic tibial osteomyelitis using microsurgical flap.J Reconstr Microsurg.2003;19:163-171.
[41]凌宏量,张路灯,陈国荣.游离肩胛皮瓣移植修复颅面部皮肤软组织缺损[J].广西医学,2012,34(6):766-767.
[42]徐军, 李森恺,李养群, 等.以旋肩胛动脉升支和降支为主轴血管的肩游离皮瓣[ J]. 中华整形外科杂志,1993,9:247-249.
[43]J Xu, S K Li, YQ Li,et al. Superior extension of the parascapular free flap for cervical burn scar contracture. Plast Reconstr Surg.1995,96:58-62.