头皮缺损伴颅骨外露的修复

目的　临床研究应用多种方法修复大面积头皮缺损伴颅骨外露。方法　用皮片移植法、头皮瓣转移加植皮法、远位皮瓣移植法、多个头皮瓣转移法及头皮扩张Ⅰ期修复头皮缺损伴颅骨外露 2 5例。结果　多个头皮瓣转移法及头皮扩张法取得良好效果 ,而皮片移植法、远位皮瓣移植法等方法均有不同程度的继发性畸形。结论　为避免继发性畸形的出现 ,多个头皮瓣转移法及头皮扩张法是修复头皮缺损伴颅骨外露的较好方法     

Ectopic implantation of an avulsed scalp with a tissue expander on a forearm for combined total scalp avulsion and spine injuries: A case report

Total scalp avulsion with severe cervical spine injury is a contraindication for emergency replantation of the scalp to its anatomical site. We describe a case involving the ectopic implantation of an avulsed scalp on the forearm. A 41‐year‐old woman presented with severe total scalp avulsion and tears in the intervertebral discs at the C4/5 and C5/6 levels. The avulsed scalp was ectopically implanted on the left forearm with a tissue expander to provide support. Two‐stage replantation of the scalp at its anatomical site was performed 19 and 40 days later. Replantation was successful, and the avulsed tissue exhibited excellent viability. In conclusion, this case shows that the ectopic implantation of the avulsed scalp on the forearm may be an option for total scalp avulsion with cervical spine injury.     

组织扩张术在瘢痕性秃发修复中的应用及疗效探讨

目的:探讨头皮扩张术治疗瘢痕性秃发的临床应用经验,强调头皮瓣设计的重要性。方法:1991年1月至2002年12月,应用头皮扩张术治疗瘢痕性秃发148例,手术选用100～500ml扩张器272个。头皮经扩张后采用如下方式进行修复:①单纯采用常规任意头皮瓣修复秃发区139例;②结合运用Orticochea多瓣法修复2例;③结合采用颞浅血管岛状头皮瓣转移修复鬓角3例、发际2例;④选择性将瘢痕性秃发区中存留的正常岛状生发头皮,形成以颞浅血管为蒂的岛状头皮瓣转移修复2例。结果:本组病例,修复秃发最大面积为310cm2,其中一典型病例,秃发面积达12cm×14cm,经一次扩张后修复全部秃发区。本组148例,一次性完全修复秃发135例,2例经接力扩张、6例经延期扩张后完全修复,剩余5例未完全修复,并发症发生率为17.6%。结论:头皮扩张术治疗大面积瘢痕性秃发有良好的整复效果,是大面积瘢痕性秃发较为理想的治疗方法。头皮扩张术结合多种类型头皮瓣设计的灵活运用可提高并改善瘢痕性秃发的修复效果。     

Replantation and triple expansion of a three-piece total scalp avulsion: six-year follow-up

Total scalp avulsion in three scalp segments is an unusual injury. The authors describe the replantation of three scalp segments in a 15-year-old girl. Replantation of the middle scalp piece was unsuccessful, but a satisfactory aesthetic and functional result was obtained by expanding the same replanted tissue three times. Every effort should be undertaken to save the avulsed scalp, even in a severely damaged situation.     

双叶旋转皮瓣在修复头皮缺损中的应用

目的：探讨和评价应用双叶旋转皮瓣修复头皮缺损的临床效果。方法：手术于局麻下进行,距头皮皮损边缘0.2cm～0.5cm完整切除皮损后,在缺损区周边正常头皮设计双叶旋转皮瓣,修复创面。结果：本组20例,缺损区域面积最大5cm×2.7cm,最小2cm×1.5cm,术后伤口均Ⅰ期愈合,皮瓣颜色、质地与周围头皮基本一致,术后随访1～12个月,皮瓣区毛发生长状况与周围头皮一致,切口瘢痕不明显,无感觉异常。结论：应用双叶旋转皮瓣修复头皮缺损,皮瓣张力小、血运丰富、易于成活,且毛发生长正常,皮瓣与周边头皮衔接良好,达到整形美容效果,是解决中小面积头皮缺损修复的一种良好方法,值得推广应用。     

扩张后交错换位头皮瓣治疗烧伤瘢痕性秃发

我们采用将扩张后呈球面的头皮分割，形成两个或几个皮瓣，以避免球面头皮难以充分展平发挥最大效益的缺点。共治疗大面积瘢痕性秃发８例，７例效果满意，１例因１个扩张器外露而被迫取出，降低了疗效。     

Surgical Anatomy of the Scalp

BACKGROUND: The goal of complication-free scalp surgery remains elusive. Wide unsightly scars, stretch-atrophied hypesthetic, poorly vascularized tissues and distorted hair patterns are still commonly seen and appear to be largely refractory to remedial surgery. OBJECTIVE: To establish technical guidelines for scalp surgery most compatible with maximum functional/cosmetic benefit and complication-free results. METHODS: More than 3000 scalp operations, done personally, were reviewed. These covered the entire spectrum of plastic and reconstructive surgery and hair restoration procedures including more than 700 clinical surgical investigative procedures with pericranial flaps, subgaleal and subperiosteal scalp reductions, and deep plane fixation procedures. RESULTS: Notably improved scalp surgery outcomes resulted from the application of data derived from study of the surgical anatomy of the scalp. Unsightly scars, distorted hair patterns, hypesthetic poorly vascularized tissues, and distorted hair patterns were largely avoided. CONCLUSION: An understanding of the surgical anatomy of the scalp is a cornerstone on which complication-free scalp surgery is based.     

头皮撕脱伤的整形外科治疗方法比较

目的 比较头皮撕脱伤的不同治疗方法.方法 通过文献阅读总结1994年～2005年,共275例头皮撕脱伤.结果 吻合血管头皮再植方法取得满意效果.结论 吻合单侧颞浅动脉即可营养整个撕脱头皮.     

Serial Scalp Reductions: A Biomechanical Approach

BACKGROUND: Several technical aspects of scalp-reduction procedures still need to be clearly elucidated: in particular, (a) the quantitative effects provided by different amounts of subgaleal undermining, (b) the immediate gains provided by increasing amount of tension when advancing a scalp flap, and (c) the eventual benefits provided by galeotomies. OBJECTIVE: The aim of the present paper is to report on some biomechanical properties of scalp flaps as related to serial scalp reduction procedures for correction of male pattern baldness. METHODS: Data were collected by stepwise loading of 20 scalp flaps, obtained by a reversed-Y scalp incision, after increasing amounts of undermining, as well as after performing three galeotomies. RESULTS: Increasing amounts of tension (while advancing a scalp flap) affect the compliance of a scalp flap in a non-linear fashion; increasing amounts of undermining permit obtaining significant, but not proportional, gains; performing galeotomies is a useful adjunct to decrease the amount of closing tension when performing scalp-reduction procedures. CONCLUSION: When performing serial scalp reductions, to take into account the biomechanics of scalp flaps may be of some utility in obtaining an optimal result.     

The Scalp Biopsy: Making it More Efficient

BACKGROUND: The scalp biopsy plays an important role in diagnosis and subsequent management of many scalp disorders. This simple diagnostic procedure can be time-consuming and frustrating for most dermatologists. OBJECTIVE: To outline an efficient technique for performing a scalp biopsy. METHODS: The technique of performing a scalp biopsy is reviewed and suggestions are made to make this time-consuming procedure more efficient. RESULTS: Sufficient specimen for histopathologic evaluation in a short perid of time is obtained. CONCLUSION: Attention to specific details in performing a scalp biopsy allows the physician to obtain a quick and histopathologically informative scalp biopsy.     

Successfully performed STA-MCA anastomosis using a branch of the STA scarcely visible on cerebral angiography in two patients with ischemic type moyamoya disease

Preparation of a scalp artery as a donor is the first step in the procedure of direct anastomosis for the treatment of ischemic type moyamoya disease. In some cases, the scalp artery is not visualized well on cerebral angiograms. Another scalp artery must be used as a donor or it is interposed between the proximal portion of the firstly selected scalp artery and a branch of the middle cerebral artery in that condition. Skin incision should be planned to include multiple scalp arteries. On cerebral angiograms, in the present two cases, the diameter and length of branches of the STA was thought to be too small and short to anastomose, but direct anastomosis was successfully performed with a single STA branch. In conclusion, skin flap should include multiple scalp arteries prepared for interposition, and each branch of the scalp arteries should be carefully inspected intraoperatively to determine whether an angiographically small and short branch of the scalp can be used to anastomose.     

连头婴头颅软组织大范围缺损的修复

目的 报告连头婴的头皮扩张术及修复分离后的头皮和硬脑膜巨大缺损的方法及经验。方法 分析头皮扩张器埋置过程中并发症发生的原因及处理措施。扩张后头皮皮瓣及纤维囊膜在头颅软组织缺损修复中应用的特点及处理注意事项等进行总结。结果 头皮扩张后，能满意地一期整复硬脑膜及头皮缺损。结论 对连头婴在埋植扩张器及分离术的术前准备及术中处理应精心策划，术后严密观察及时处理并发症，对保证分离手术的成功，有重要的辅助作用。     

Skin expansion to eliminate large scalp defects

In three children aged 3 to 8 years with large scalp defects temporary expanders of silicone elastomer were inserted under the scalp above the pericranium and under the galea through an incision at the junction of the defect and the normal scalp. Over the following six to eight weeks, the expanders were inflated weekly or semiweekly with injections of saline. During expansion, hair growth continued. When the scalp flap expansion was completed, the scalp margin was advanced. Two of the 3 patients required additional expansion, so a deflated expander was left under the scalp. The entire defect was covered in each case. This technique has wide application for a variety of reconstructive problems.     

Reconstruction of massive defects of the scalp, cranium, and dura after resection of scalp neoplasms

Massive defects of the scalp, cranium, and dura can be covered with local rotation, transposition scalp flaps. Five cases of massive defects of up to 300 square centimeters resulting from resection of scalp neoplasms were reconstructed by this technique. Excellent cosmetic and functional results were obtained in all cases. Although the emphasis in the recent literature has been on free flap coverage of these massive defects, our series demonstrates that these extensive scalp defects can be reconstructed using large local scalp flap transposition.     

Aplasia cutis congenita associated with an immature arteriovenous malformation

Summary The first case of congenital defect of the skull and scalp in Japan, probably due to an immature arteriovenous malformation, is presented. In this case, an island of healthy scalp remained intact in the central area of the scalp defect, unlike previously reported cases. The dilated, tortuous scalp vessels apparently disappeared spontaneously only after multiple ligation. Because of slow wound healing, three successive operations were subsequently needed to cover the scalp defect. The cause of the aplasia cutis congenita and the delayed wound healing mechanism was investigated histologically.     

Aesthetic Reconstruction of Burn Alopecia by Using Expanded Hair-Bearing Scalp Flaps

Tissue expansion is one of the most important armamentaria for aesthetic scalp reconstruction after burn; however, the proper way to employ this technique for the scalp reconstruction usually presents a challenge to the plastic surgeon, especially in the case of a ``sideburn' scenario or a large lesion, as with, for example, hemiscalp alopecia. In this article, 11 patients, with different degrees of hair-bearing scalp loss as a result of burn, and including four patients with hemiscalp alopecia were successfully treated by using tissue expansion. The results show that tissue expansion is a simple, safe, and efficient technique for aesthetic scalp reconstruction. Versatile design of the expanded scalp flap can distribute the expanded hair-bearing scalp properly in the reconstructed recipient site.     

Use of a halo frame for optimum intra- and post-operative management after scalp replantation/revascularization

We present a new technique for stabilizing an avulsed scalp during and after replantation/revascularization. We used an aluminium “halo” frame with 4 screws. This technique can rigidly stabilize an avulsed scalp and eliminate the possibility of shearing/pressure necrosis. This device can make perioperative management easier and more comfortable for the patient and caregivers.KEY WORDS: Scalp avulsion, scalp replantation, scalp revascularization, scalp stabilization     

Squamous Cell Carcinoma of the Scalp After Radiotherapy for Tinea Capitis

BACKGROUND: Radiotherapy for tinea capitis was widely used in the 1930s and 1940s. There is a fourfold increase in the risk for developing nonmelanoma skin cancer in the scalp. Excision of lesions is challenging, as tissue around the wound is atrophic and susceptible to ischemia. OBJECTIVE: To discuss the risk of skin cancer in the older patient who received scalp radiotherapy in childhood and options for scalp reconstruction after excision. METHODS: A woman developed squamous cell carcinoma on the scalp 67 years after radiotherapy for tinea capitis. RESULTS: The large excision defect was successfully grafted, avoiding the need for complex scalp reconstruction. CONCLUSION: Patients who received scalp radiotherapy in childhood are at increased risk of developing nonmelanoma skin cancer. The unique anatomy of scalp tissue makes it difficult to close excisional defects. Skin grafting often fails, and complex flaps or the importation of vascularized tissue may be required.     

Repair of scalp defect using a superficial temporal fascia pedicle VY advancement scalp flap.

Repair of scalp defects using a superficial temporal fascia pedicle VY advancement scalp flap, which is supplied by superficial temporal vessels, is reported. This method has been used in seven cases of scalp defects, and enables us to provide primary closure of the defects with hair-bearing scalp skin. This method is simple, easy, and reliable.     

头皮扩张后皮瓣移位修复毛发缺损

目的 观察扩张后头皮瓣移位修复毛发缺损的效果。方法 按发区缺损的范围。形状，于正常发区边缘埋置1-3个大小不等的扩张器，间隔3d注射生理盐水扩张，3-7周后移位修复缺损区。结果 临床应用20例，30个扩张囊，除2例扩张中期部分扩张器外露，其余均正常。结论应用扩张后的头皮瓣修复发区缺损。使用灵活，效果可靠。小面积缺损可用1个扩张器，大面积缺损可同时应用多个扩张器，供区不需植皮，修复的发区外形满意。