CLINICAL APPLICATION OF FREE FLAP ON REPAIR OF SCALP DEFECT AFTER RESECTION OF MALIGNANT TUMOR IN 18 CASES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIAOHaitao , WANGHuaisheng ,  LIUXiaoxue , LIUYong ,  CENYing

Department of Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

LIUXiaoxue, Email: liuxiaoxue0930@126.com; CENYing, Email: cenying0141@163.com

Keywords：

Scalp malignant tumor; Free flap; Wound repair

DOI：

10.7507/1002-1892.20160018

Video：

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Objective To investigate the effectiveness of different free flaps in the repair of large defects after resection of scalp malignant tumors. Method Between March 2012 and January 2015, 18 patients with large defect after resection of scalp malignant tumors were treated with different free flaps. There were 13 males and 5 females with an average age of 49 years (range, 18-72 years). There were 17 cases of squamous carcinoma and 1 case of dermato-fibril sarcoma protuberans. The defect size ranged from 15 cm×12 cm to 22 cm×17 cm after resection of tumors. Defects were repaired with anterolateral thigh flap in 5 cases, latissimus dorsi myocutaneous flap in 6 cases, thoracodorsal artery perforator flap in 3 cases, and latissimusdorsi muscle flap plus intermediate split thickness skin graft in 4 cases. The flap size was 17 cm×14 cm to 24 cm×19 cm. The donor sites of the skin flap were covered with skin graft, while the donor sites of the muscle flap were directly sutured. Results Of 14 skin flaps, the other 13 flaps survived except 1 flap necrosis; all muscle flaps survived. The patients were followed up 5-33 months (mean, 20 months). Three patients died because of intracranial metastasis at 5, 7, and 13 months after operation, respectively. Two patients had local recurrence and underwent secondary operation. The results of both appearance and function were satisfactory; secondary operation of thinning the flaps was performed in 4 cases of bulky flaps. The flaps had good wear resistance, without ulceration during follow-up. No obvious impairment was observed after harvesting latissimus dorsi myocutaneous flap. Conclusions Large scalp defects after malignant tumor resection can be effectively repaired by proper application of different free flaps.

Citation： XIAOHaitao, WANGHuaisheng, LIUXiaoxue, LIUYong, CENYing. CLINICAL APPLICATION OF FREE FLAP ON REPAIR OF SCALP DEFECT AFTER RESECTION OF MALIGNANT TUMOR IN 18 CASES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(1): 87-90. doi: 10.7507/1002-1892.20160018 Copy

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2.	张茂红,杜庆安,李侃.肿瘤整形外科技术在头皮肿瘤手术中的应用.中国肿瘤外科杂志, 2012, 4(2) :72-75.
3.	袁好军,安静,孙宇航,等.帽状腱膜下筋膜瓣加植皮一期修复头皮大面积缺损伴颅骨外露.中国美容医学, 2014, 23(7) :526-528.
4.	葛礼正,刘安军,郭利刚,等.颞浅动脉及其吻合支为蒂的头皮瓣在修复头皮缺损颅骨外露中的临床应用.中华整形外科杂志, 2014, 30(6) :466-468.
5.	卿勇,岑瑛,王怀胜,等.头皮恶性肿瘤外科切除后的修复.中国修复重建外科杂志, 2008, 22(1) :59-62.
6.	Desai SC, Sand JP, Sharon JD, et al. Scalp reconstruction:an algorithmic approach and systematic review. Facial Plast Surg, 2015, 17(1) :56-66.
7.	鲍世威,马小兵,赵红艺,等.游离肩胛皮瓣移植修复头皮大面积缺损合并骨外露.中国组织工程研究, 2014, 18(51) :8315-8319.
8.	朱薛锋,邓景成,蒋朝华,等.头皮撕脱伤显微外科再植的急救处理.组织工程与重建外科杂志, 2015, 11(3) :152-155.
9.	Chao AH, Yu P, Skoracki RJ, et al. Microsurgical reconstruction of composite scalp and calvarial defects in patients with cancer:a 10-year experience. Head Neck, 2012, 34(12) :1759-1764.
10.	汤海萍,腾国栋,姜凯.游离皮瓣在颅骨外露的头皮缺损中的应用.中国美容医学, 2013, 22(4) :431-433.
11.	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.实用医学杂志, 2011, 27(21) :3984-3985.
12.	张万锋,梁峰,李金有,等.带阔筋膜的股前外侧穿支组织瓣修复组织缺损.中华烧伤杂志, 2013, 29(5) :427-431.
13.	何永静,王继华,杨云,等. CT血管造影在背阔肌皮瓣游离移植修复头皮撕脱伤创面中的应用.中国修复重建外科杂志, 2013, 27(3) :299-303.
14.	李晓亮,夏成德,狄海萍,等.游离背阔肌皮瓣修复头部放射性溃疡一例.中华损伤与修复杂志(电子版), 2014, 9(2) :87-88.
15.	唐举玉,杜威,宋达疆,等.胸背动脉穿支皮瓣移植修复不同部位皮肤软组织缺损16例.中华整形外科杂志, 2013, 29(3) :178-180.
16.	杜威.胸背动脉穿支皮瓣的研究进展.中国临床解剖学杂志, 2013, 31(3) :365-367.
17.	Hwang JH, Lim SY, Pyon JK, et al. Reliable harvesting of a large thoracodorsal artery perforator flap with emphasisi on perforator number and spacing. Plast Reconstr Surg, 2011, 128(3) :140e-150e.
18.	Daigeler A, Zmarsly I, Hirsch T, et al. Long-term outcome after local recurrence of soft tissue sarcoma:a retrospective analysis of factors predictive of survival in 135 patients with locally recurrent soft tissue sarcoma. Br J Cancer, 2014, 110(6) :1456-1464.

1. 徐剑,欧阳电.头颈部恶性外毛根鞘癌的临床特点及预后分析.吉林医学, 2014, 35(10) :2079-2081.
2. 张茂红,杜庆安,李侃.肿瘤整形外科技术在头皮肿瘤手术中的应用.中国肿瘤外科杂志, 2012, 4(2) :72-75.
3. 袁好军,安静,孙宇航,等.帽状腱膜下筋膜瓣加植皮一期修复头皮大面积缺损伴颅骨外露.中国美容医学, 2014, 23(7) :526-528.
4. 葛礼正,刘安军,郭利刚,等.颞浅动脉及其吻合支为蒂的头皮瓣在修复头皮缺损颅骨外露中的临床应用.中华整形外科杂志, 2014, 30(6) :466-468.
5. 卿勇,岑瑛,王怀胜,等.头皮恶性肿瘤外科切除后的修复.中国修复重建外科杂志, 2008, 22(1) :59-62.
6. Desai SC, Sand JP, Sharon JD, et al. Scalp reconstruction:an algorithmic approach and systematic review. Facial Plast Surg, 2015, 17(1) :56-66.
7. 鲍世威,马小兵,赵红艺,等.游离肩胛皮瓣移植修复头皮大面积缺损合并骨外露.中国组织工程研究, 2014, 18(51) :8315-8319.
8. 朱薛锋,邓景成,蒋朝华,等.头皮撕脱伤显微外科再植的急救处理.组织工程与重建外科杂志, 2015, 11(3) :152-155.
9. Chao AH, Yu P, Skoracki RJ, et al. Microsurgical reconstruction of composite scalp and calvarial defects in patients with cancer:a 10-year experience. Head Neck, 2012, 34(12) :1759-1764.
10. 汤海萍,腾国栋,姜凯.游离皮瓣在颅骨外露的头皮缺损中的应用.中国美容医学, 2013, 22(4) :431-433.
11. 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.实用医学杂志, 2011, 27(21) :3984-3985.
12. 张万锋,梁峰,李金有,等.带阔筋膜的股前外侧穿支组织瓣修复组织缺损.中华烧伤杂志, 2013, 29(5) :427-431.
13. 何永静,王继华,杨云,等. CT血管造影在背阔肌皮瓣游离移植修复头皮撕脱伤创面中的应用.中国修复重建外科杂志, 2013, 27(3) :299-303.
14. 李晓亮,夏成德,狄海萍,等.游离背阔肌皮瓣修复头部放射性溃疡一例.中华损伤与修复杂志(电子版), 2014, 9(2) :87-88.
15. 唐举玉,杜威,宋达疆,等.胸背动脉穿支皮瓣移植修复不同部位皮肤软组织缺损16例.中华整形外科杂志, 2013, 29(3) :178-180.
16. 杜威.胸背动脉穿支皮瓣的研究进展.中国临床解剖学杂志, 2013, 31(3) :365-367.
17. Hwang JH, Lim SY, Pyon JK, et al. Reliable harvesting of a large thoracodorsal artery perforator flap with emphasisi on perforator number and spacing. Plast Reconstr Surg, 2011, 128(3) :140e-150e.
18. Daigeler A, Zmarsly I, Hirsch T, et al. Long-term outcome after local recurrence of soft tissue sarcoma:a retrospective analysis of factors predictive of survival in 135 patients with locally recurrent soft tissue sarcoma. Br J Cancer, 2014, 110(6) :1456-1464.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL APPLICATION OF FREE FLAP ON REPAIR OF SCALP DEFECT AFTER RESECTION OF MALIGNANT TUMOR IN 18 CASES

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