保留钛网清创后移植皮瓣/肌皮瓣修复颅骨成形术后钛网外露创面的临床效果

何林; 王瑞; 朱婵; 余学元; 何佑成; 周林; 张卓; 舒茂国

doi:10.3760/cma.j.cn501225-20231031-00163

保留钛网清创后移植皮瓣/肌皮瓣修复颅骨成形术后钛网外露创面的临床效果

doi: 10.3760/cma.j.cn501225-20231031-00163

何林¹,
王瑞¹,
朱婵²,
余学元¹,
何佑成¹,
周林¹,
张卓¹,
舒茂国^1, ,

1.
西安交通大学第一附属医院整形美容颌面外科，西安　　710061
2.
空军军医大学第一附属医院全军烧伤中心，烧伤与皮肤外科，西安　　710032

基金项目:

陕西省重点研发计划 2023-YBSF-179

详细信息

通讯作者:
舒茂国，Email：shumaoguo@163.com

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出版历程
- 收稿日期: 2023-10-31

Clinical effects of flaps or myocutaneous flaps transplantation after titanium mesh-retaining debridement in repairing the wounds with exposed titanium mesh after cranioplasty

1.
Department of Plastic, AestheticMaxillofacial Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
2.
Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

Key Research and Development Plan of Shaanxi Province of China 2023-YBSF-179

More Information

Corresponding author: Shu Maoguo, Email: shumaoguo@163.com

摘要

摘要: 目的探讨在保留钛网的情况下，清创后行皮瓣/肌皮瓣移植修复颅骨成形术后钛网外露创面的临床效果。方法该研究为回顾性观察性研究。2017年2月—2022年10月，西安交通大学第一附属医院整形美容颌面外科收治22例符合入选标准的颅骨成形术后钛网外露患者，其中男15例、女7例，年龄19~68岁。入院后行创面分泌物标本细菌培养、抗感染、换药等处理，待创面改善后，行手术彻底清创，清创后创面面积为3.0 cm×2.0 cm~11.0 cm× 8.0 cm。根据创面大小、部位、感染严重程度及周围组织情况，选择采用局部皮瓣、扩张皮瓣或者游离背阔肌肌皮瓣修复创面，皮瓣或肌皮瓣面积为5.5 cm×4.0 cm~18.0 cm×15.0 cm。将皮瓣供区直接拉拢缝合或采用头部刃厚皮片修复。记录采用的创面修复方式。观察术后皮瓣或肌皮瓣成活情况及术后2周创面愈合情况。术后随访时，观察钛网植入区域有无再次感染或钛网外露情况发生，观察患者头部外形、手术切口瘢痕形成情况及秃发情况。末次随访时，评估患者对治疗效果的满意度（分为满意、基本满意、不满意3个等级）。统计患者住院期间总治疗费用。结果 11例患者创面采用局部皮瓣修复，5例患者创面采用扩张皮瓣修复，6例患者创面采用游离背阔肌肌皮瓣修复。所有皮瓣或肌皮瓣术后均完全成活，术后2周创面均愈合良好。术后随访6~48个月，仅1例行局部皮瓣移植患者术后1个月余再次出现钛网植入区域感染，经治疗无效后取出钛网。除1例去除钛网的患者头部局部凹陷外，其余患者头部外形饱满。除6例患者肌皮瓣移植区域及1例行局部皮瓣移植患者皮片移植区域无头发生长外，其余患者未见秃发。所有患者手术切口瘢痕隐蔽。末次随访时，对治疗效果满意者19例、基本满意者2例、不满意者1例。患者住院期间总治疗费用为11 764~36 452（22 304±6 955）元。结论对于颅骨成形术后钛网外露，在充分术前准备和彻底清创的前提下，根据创面情况选择合适的皮瓣或肌皮瓣修复，能保留全部或部分钛网，术后创面愈合良好，钛网植入区域再次发生感染或钛网外露情况少，头部外形良好，手术次数减少，治疗费用降低。
- 外科皮瓣 /
- 肌皮瓣 /
- 感染 /
- 颅骨成形术 /
- 钛网外露 /
- 创面修复
Abstract: Objective To explore the clinical effects of flaps or myocutaneous flaps transplantation after debridement to repair the wounds with exposed titanium mesh after cranioplasty on the premise of retaining the titanium mesh. Methods This study was a retrospective observational study. From February 2017 to October 2022, 22 patients with titanium mesh exposure after cranioplasty who met the inclusion criteria were admitted to the Department of Plastic, Aesthetic & Maxillofacial Surgery of the First Affiliated Hospital of Xi'an Jiaotong University, including 15 males and 7 females, aged from 19 to 68 years. After admission, treatments such as bacterial culture of wound exudate sample, anti-infection, and dressing change were carried out. Thorough surgical debridement was performed when the wound improved, and the wound area was 3.0 cm×2.0 cm to 11.0 cm×8.0 cm after debridement. The wound was repaired with local flaps, expanded flaps, or free latissimus dorsi myocutaneous flaps according to the size, location, severity of infection, and surrounding tissue condition of the wounds, and the areas of flaps or myocutaneous flaps were 5.5 cm×4.0 cm to 18.0 cm×15.0 cm. The donor areas of flaps were sutured directly or repaired by split-thickness skin grafts from head. The wound repair method was recorded. The survivals of flaps or myocutaneous flaps after surgery and wound healing in 2 weeks after surgery were recorded. During postoperative follow-up, recurrence of infection or titanium mesh exposure in the implanted area of titanium mesh was observed; the head shapes of patients, scar formation of the operative incision, and baldness were observed. At the last follow-up, the satisfaction of patients with the treatment effect (dividing into three levels: satisfied, basically satisfied, and dissatisfied) was evaluated. The total treatment costs of patients during their hospitalization were calculated. Results The wounds in 11 cases were repaired with local flaps, the wounds in 5 cases were repaired with expanded flaps, and the wounds in 6 cases were repaired with free latissimus dorsi myocutaneous flaps. All flaps or myocutaneous flaps survived completely after surgery, and all wounds healed well in 2 weeks after surgery. Follow up for 6 to 48 months after operation, only one patient with local flap grafting experienced a recurrence of infection in the titanium mesh implanted area at more than one month after surgery, and the titanium mesh was removed because of ineffective treatment. Except for one patient who had a local depression in the head after removing the titanium mesh, the rest of the patients had a full head shape. Except for myocutaneous flap grafting areas in 6 cases and skin grafting area in 1 case with local flaps grafting had no hair growth, the other patients had no baldness. All the scars in surgical incision were concealed. At the last follow-up, 19 cases were satisfied with the treatment effects, 2 cases were basically satisfied, and 1 case was dissatisfied. The total treatment cost for patients in this group during hospitalization was 11 764-36 452 (22 304±6 955) yuan. Conclusions For patients with titanium mesh exposure after cranioplasty, on the premise of adequate preoperative preparation and thorough debridement, the wound can be repaired with appropriate flaps or myocutaneous flaps according to the wound condition. The surgery can preserve all or part of the titanium mesh. The postoperative wound healing is good and the recurrence of infection or titanium mesh exposure in the titanium mesh implanted area is reduced, leading to good head shape, reduced surgical frequency, and decreased treatment costs.
- Surgical flaps /
- Myocutaneous flap /
- Infection /
- Cranioplasty /
- Titanium mesh exposure /
- Wound repair
何林：手术设计和操作，论文撰写；王瑞、舒茂国：手术设计和操作，论文修改；朱婵：患者管理，患者随访，统计分析；余学元、何佑成、周林、张卓：患者管理，手术操作

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参考文献(35)

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1 采用头顶部扩张皮瓣修复例1患者左颞部颅骨成形术后钛网外露创面的效果。1A.入院时左颞部钛网外露，创面干燥；1B.术前头颅三维CT检查显示钛网面积为12.0 cm×8.0 cm；1C.术前头颅CT平扫提示钛网与硬脑膜贴合紧密，钛网下无积液积脓；1D.皮肤软组织扩张器置入并注水扩张3个月后；1E.扩张皮瓣转移术后1个月，皮瓣存活良好，创面愈合良好；1F.术后48个月，头部外形正常，无秃发，未见切口瘢痕

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2 采用游离背阔肌肌皮瓣修复例2患者右颞部颅骨成形术后钛网外露创面的效果。2A.入院时右颞部钛网外露，创面有分泌物；2B.术前头颅三维CT检查显示钛网面积为15.0 cm×12.0 cm；2C.术前头颅CT平扫提示钛网与硬脑膜贴合紧密，钛网下无积液积脓；2D.清创后，完整保留钛网；2E.游离背阔肌肌皮瓣转移术后即刻；2F.术后6个月，无再次感染或钛网外露，头部外形正常，肌皮瓣稍臃肿

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