背景:头皮缺损重建带来了相当大的挑战,关于最有效策略的辩论正在进行。虽然背阔肌(LD)皮瓣传统上受到青睐,股前外侧(ALT)皮瓣已被充分描述为解决广泛的头皮缺陷的通用替代方法。这项研究强调了使用ALT皮瓣重建头皮的成功,特别是推动先前报道的襟翼尺寸的边界。我们的方法利用吲哚菁绿(ICG)灌注来指导精确的术前计划和血管修饰,有助于在具有挑战性的情况下改善结果。
方法:我们在2016年至2023年之间对头皮缺损进行了43个ALT皮瓣重建。我们收集了患者的人口统计学和临床数据,并评估了皮瓣大小和受体血管以及其他手术技术。进行详细的术前计划,并使用超声和ICG进行术中计划,以找到穿支器位置。这群人被分成了两个,皮瓣有或没有并发症,并根据其手术细节进行分析。
结果:本研究涉及38例广泛头皮缺损患者(平均年龄:69.4±11岁),接受ALT穿支皮瓣转移(平均皮瓣大小:230.88±145.6cm2)。只有一例皮瓣转移不成功,四例有一些并发症。并发症组的特点包括大尺寸皮瓣(303.1±170.9vs.214.9±136.6cm2,P=.211),没有椎弓根操纵的穿孔器数量很少,术中缺乏吲哚菁绿(75%vs.25%,P=.607),以及使用颞浅表血管作为受体血管。
结论:在成像方式的帮助下,使用大ALT游离皮瓣进行头皮重建有助于优化手术技术,比如椎弓根操纵,射孔器编号,和静脉考虑,有助于成功重建。
BACKGROUND: Scalp defect reconstruction poses considerable challenges, with ongoing debates regarding the most effective strategies. While the latissimus dorsi (LD) flap has traditionally been favored, the anterolateral
thigh (ALT) flap has been well described as a versatile alternative for addressing extensive scalp defects. This study underscores the success of scalp reconstruction using ALT flaps, notably pushing the boundaries of previously reported flap sizes. Our approach leverages the use of indocyanine green (ICG) perfusion to guide precise preoperative planning and vascular modification, contributing to improved outcomes in challenging cases.
METHODS: We performed 43 ALT flap reconstructions for scalp defects between 2016 and 2023. We collected patients\' demographic and clinical data and evaluated flap size and recipient vessels and additional surgical techniques. Detailed preoperative plans with ultrasound and ICG use for intraoperative plans were performed to find perforators location. The cohort was divided into two, with or without complications on flaps, and analyzed depending on its surgical details.
RESULTS: This study involved 38 patients with extensive scalp defects (mean age: 69.4 ± 11 years) who underwent ALT perforator flap transfers (mean flap size: 230.88 ± 145.6 cm2). There was only one case of unsuccessful flap transfer, and four cases had a few complications. The characteristics of the complication group included a large flap size (303.1 ± 170.9 vs. 214.9 ± 136.6 cm2, P = .211), few perforator numbers without pedicle manipulation, lack of intraoperative indocyanine green administration (75% vs. 25%, P = .607), and the use of superficial temporal vessels as recipient vessels.
CONCLUSIONS: Scalp reconstruction using large ALT free flaps with the aid of imaging modalities facilitates the optimization of surgical techniques, such as pedicle manipulation, perforator numbers, and vein considerations, thereby contributing to successful reconstruction.