目的:比较全厚度皮肤移植和裂层皮肤移植在头皮重建中的应用。
方法:回顾性图表回顾了2011年至2016年在一家机构进行的皮肤移植头皮重建的患者。
方法:使用χ2或Fisher精确检验比较移植物整合和并发症发生率。移植物类型的影响,缺陷类型,移植物大小,采用多因素logistic回归分析患者合并症对移植成功可能性和并发症的影响.
结果:在200例患者中进行了125例全厚度和93例分厚度移植,包括68个缺损(31.2%)与暴露的颅骨。全厚度移植物需要较少的平均重建(P=0.002)。92.8%的全层移植物具有完全的移植物整合,而78.5%的分层移植物具有完全的移植物整合(P=0.002)。这种差异在暴露的颅骨缺损中更为明显(87.2%vs.47.6%,P≤0.001)。尽管轻微清创率较高,全层移植物的术后骨暴露和伤口破裂少于完整的围膜和暴露的颅骨缺损。术前放射,免疫抑制,移植物大小增加是移植物结局的重要预测因素。
结论:皮肤移植,尤其是全厚度,提供一个多才多艺的,可靠,以及在适当的患者中重建中等至较大头皮缺陷的简单方法。即使在裸露的颅骨缺损上,当准备好血管化受体床时,全层移植物可以成功。骨外露的缺损,较大的移植物尺寸,术前放疗,和免疫抑制可能导致减少移植和增加的并发症。
方法:3b。
OBJECTIVE: Compare full-thickness skin grafts versus split-thickness skin grafts in scalp reconstruction.
METHODS: Retrospective chart review of patients who underwent scalp reconstruction with skin grafts performed at a single institution from 2011 to 2016.
METHODS: χ2 or Fisher exact tests were used to compare graft integration and complication rates. The effects of graft type, defect type, graft size, and patient comorbidities on the likelihood of graft success and complications were analyzed using multivariate logistic regression.
RESULTS: A hundred and twenty-five full-thickness and 93 split-thickness grafts were performed in 200 patients, including 68 defects (31.2%) with exposed calvarium. Full-thickness grafts required fewer average reconstructions (P = 0.002). A 92.8% of full-thickness grafts had complete graft integration compared with 78.5% of split-thickness grafts (P = 0.002). This difference was more evident in defects with exposed calvarium (87.2% vs. 47.6%, P ≤ 0.001). Despite higher rates of minor debridement, full-thickness grafts had less postoperative bone exposure and wound breakdown than split-thickness grafts on intact pericranium and exposed calvarium defects. Preoperative radiation, immunosuppression, and increased graft sizes were significant predictors of graft outcomes.
CONCLUSIONS: Skin grafts, especially full-thickness, provide a versatile, reliable, and simple approach for reconstructing medium to large scalp defects in the appropriate patient. Even on defects with bare calvarium, full-thickness grafts can succeed when a vascularized recipient bed is prepared. Defects with exposed bone, larger graft sizes, preoperative radiation, and immunosuppression may result in decreased graft take and increased complications.
METHODS: 3b.