目的 探讨股前外侧复合组织瓣游离移植修复头部皮肤缺损伴人工硬脑膜裸露感染的效果。方法 回顾性研究2018年4月至2020年8月空军军医大学第一附属医院收治的13例颅脑皮肤软组织缺损合并人工硬脑膜裸露伴感染的患者，均为开颅术后并发症。经术前抗感染治疗后，术中神经外科参与清创并尽可能去除人工硬脑膜，设计携阔筋膜的股前外侧复合组织瓣，用皮瓣动静脉分别与颞浅动脉、颞浅静脉/颞中静脉吻合，用带血供的阔筋膜修补缺损硬脑膜，皮瓣封闭创面，供瓣区直接缝合或移植自体中厚皮片。观察术后皮瓣血运及成活情况、有无脑脊液漏、供瓣区愈合情况;随访行头颅磁共振成像检查观察硬脑膜完整性以及颅骨重建术后效果。结果 本组13例患者中，11例患者人工硬脑膜全部去除干净，2例患者因粘连严重未全部清除，其中1例残余0。8 cm × 1 cm，另1例有3处残余，最大面积0。5 cm ×0。7 cm;所有移植皮瓣均成活，其中12例患者一期愈合，1例皮瓣拆线后部分伤口裂开，经保守换药后愈合;所有患者均无脑脊液漏;1例供瓣区移植皮片部分坏死，补充植皮后愈合;13例患者术后3～6个月头颅磁共振成像检查均显示硬脑膜完整;其中8例患者已完成颅骨重建手术，重建术后均愈合良好，术区外观良好。结论 对于头部皮肤缺损伴人工硬脑膜裸露感染的创面，采用携带阔筋膜的股前外侧复合组织瓣游离移植修复，能有效地覆盖创面并修复硬脑膜缺损，获得良好的功能和外形，并能为后期颅骨重建创造有利条件。
Clinical observation of free composite tissue flap transplantation in repairing head skin defect with artificial dural exposure infection
Objective To explore the effect of free transplantation of composite tissue flap from the anterior lateral aspect of the femur in repairing head skin defects with artificial dural exposure infection.Methods A retrospective study was conducted on 13 patients admitted to the First Affiliated Hospital of Air Force Military Medical University from April 2018 to August 2020 with craniotomy complications,including craniotomy skin and soft tissue defects combined with artificial dural exposure and infection.After preoperative anti infection treatment,the neurosurgery department participated in debridement and removed the artificial dura mater as much as possible during the operation.A composite tissue flap carrying the fascia lata was designed for the anterior lateral aspect of the thigh,and the flap artery and vein were anastomosed with the superficial temporal artery and superficial temporal vein/middle temporal vein respectively.The defect of the dura mater was repaired with the fascia lata with blood supply.The flap was used to seal the wound,and the donor site was directly sutured or transplanted with autologous medium thick skin graft.The postoperative blood supply and survival of the flap,the presence of cerebrospinal fluid leakage,and the healing of the donor site were observed;The observation of dural integrity and postoperative effects of skull reconstruction using cranial magnetic resonance imaging was followed up.Results Among the 13 patients in this group,11 patients had their artificial dura mater completely removed,while 2 patients were not completely removed due to severe adhesion.Among them,1 patient had a residual area of 0.8 cm × 1 cm,and the other had 3 residual areas,with a maximum area of 0.5 cm × 0.7 cm;All transplanted skin flaps survived,with 12 cases achieving primary healing and 1 case of partial wound rupture after suture removal,which healed after conservative dressing change;All patients had no cerebrospinal fluid leakage;There was one case of partial necrosis of the graft in the donor site,which healed after supplementing the graft;Thirteen patients underwent cranial magnetic resonance imaging at 3-6 months postoperatively,all of which showed intact dura mater;Among them,8 patients have completed skull reconstruction surgery,and all of them have healed well after reconstruction,with a good appearance of the surgical area.Conclusions For wounds with head skin defects and exposed artificial dura mater infection,free transplantation of the anterior lateral composite tissue flap carrying the fascia lata can effectively cover the wound and repair the dura mater defect,achieve good function and appearance,and create favorable conditions for later skull reconstruction.
Free tissue flapsDermatologic surgical proceduresScalp defectDura mater defect
万方数据
维普
