头皮扩张术治疗伴有颅骨缺损及感染头皮瘢痕.docVIP

头皮扩张术治疗伴有颅骨缺损及感染头皮瘢痕[摘要]目的：探讨应用头皮扩张术治疗伴有颅骨缺损及感染的头皮瘢痕的方法。方法：对15例头皮瘢痕伴有颅骨缺损及感染的患者，术前均行头颅CT及三维CT检查，经过换药及局部清创后，置入扩张器扩张头皮后，切除瘢痕，覆盖创面。结果：所有患者均获得满意手术效果，皮瓣全部成活，无神经系统并发症。结论：详尽的术前检查，足够量的扩张皮肤，与神经外科的合作，是手术成功的关键。 [关键词]头皮扩张术；颅骨缺损；神经系统 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2009）03-0285-03 Application of scalp expansion for repairing scalp scar with skull defect and infection YU Bing,ZHANG Zhi-yong,ZUO Feng,LEI Hua,NIU Feng,TANG Xiao-jun,LIU Jian-feng,MA Gui-e,GUI Lai (Department of Cranio Maxillo Facial Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100041,China) Abstract: Objective To explore the method of scalp expansion to treat scalp scar with skull defect and infection. Methods 15 patients with scalp scar with skull defects and infection were treated. All patients received CT and three dimensional CT scan of skull before treatment. The expanders were implanted after gauze changing and debridement. The scar was excised and wound was covered by expanding scalp. Results All patients had satisfactory results. The flaps survived with excellent appearance and no side effects of nervous system occurred. Conclusions Detailed exam before operation, enough expanded scalp and cooperation with neurosurgeon are the keys of operation success. Key words: scalp expansion, skull defects, nervous system 头皮部烧伤、烫伤、电击伤后，往往形成瘢痕性秃发，其中相当一部分患者伴有感染，颅骨缺损。此类患者的治疗较为复杂，特别伴有颅骨缺损的患者，伴有感染的瘢痕与硬脑膜粘连紧密，稍有不慎就有可能造成脑脊液漏，使感染波及颅内，如颅骨缺损区位于中线部，则经过矢状窦，使治疗更具风险。我科应用头皮软组织扩张术治疗此类头皮病变共15例，取得了满意的效果。 1临床资料 本组患者15例，10例男性，5例女性，年龄41～55岁。烧伤患者7例，电击伤患者8例，均为头皮瘢痕患者，且伴有感染及颅骨缺损。其中4例颅骨缺损经过中线，3例颅骨缺损位于矢状窦前1/3，1例颅骨缺损位于矢状窦中1/3。病变面积最大24cm×25cm,最小7cm×8cm,扩张器150～500ml，均行一定程度的超量扩张。10例取出扩张器同时行颅骨缺损修补。 2手术方法 2.1 感染头皮瘢痕创面行清创换药后，待感染得到一定的控制，于病变外侧正常头皮帽状腱膜下埋置扩张器，埋置扩张器时切口位于病变与正常头皮交界处，设计时可考虑将扩张器置入知名血管头皮下，对于大面积头皮病变伴有颅骨缺损通过中线的患者，可以确保扩张皮瓣的血供。 2.2 扩张器置入后，常规注入生理盐水，每周1～2次，总注水量为扩张器2～4倍。皮尺测量皮瓣的扩张量，估计能否覆盖病灶。对感染头皮瘢痕继续换药，每周2～3次。行头颅CT及三维CT检查，数据可为颅骨缺损设计修补材料，同时观察过中线颅骨缺损区矢状窦上