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.	張茂紅,杜慶安,李侃.腫瘤整形外科技術在頭皮腫瘤手術中的應用.中國腫瘤外科雜志, 2012, 4(2) :72-75.
3.	袁好軍,安靜,孫宇航,等.帽狀腱膜下筋膜瓣加植皮一期修復頭皮大面積缺損伴顱骨外露.中國美容醫學, 2014, 23(7) :526-528.
4.	葛禮正,劉安軍,郭利剛,等.顳淺動脈及其吻合支為蒂的頭皮瓣在修復頭皮缺損顱骨外露中的臨床應用.中華整形外科雜志, 2014, 30(6) :466-468.
5.	卿勇,岑瑛,王懷勝,等.頭皮惡性腫瘤外科切除后的修復.中國修復重建外科雜志, 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.	鮑世威,馬小兵,趙紅藝,等.游離肩胛皮瓣移植修復頭皮大面積缺損合并骨外露.中國組織工程研究, 2014, 18(51) :8315-8319.
8.	朱薛鋒,鄧景成,蔣朝華,等.頭皮撕脫傷顯微外科再植的急救處理.組織工程與重建外科雜志, 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.	湯海萍,騰國棟,姜凱.游離皮瓣在顱骨外露的頭皮缺損中的應用.中國美容醫學, 2013, 22(4) :431-433.
11.	王煒,李華.游離股前外側皮瓣一期修復頭皮鱗狀細胞癌術后大面積缺損.實用醫學雜志, 2011, 27(21) :3984-3985.
12.	張萬鋒,梁峰,李金有,等.帶闊筋膜的股前外側穿支組織瓣修復組織缺損.中華燒傷雜志, 2013, 29(5) :427-431.
13.	何永靜,王繼華,楊云,等. CT血管造影在背闊肌皮瓣游離移植修復頭皮撕脫傷創面中的應用.中國修復重建外科雜志, 2013, 27(3) :299-303.
14.	李曉亮,夏成德,狄海萍,等.游離背闊肌皮瓣修復頭部放射性潰瘍一例.中華損傷與修復雜志(電子版), 2014, 9(2) :87-88.
15.	唐舉玉,杜威,宋達疆,等.胸背動脈穿支皮瓣移植修復不同部位皮膚軟組織缺損16例.中華整形外科雜志, 2013, 29(3) :178-180.
16.	杜威.胸背動脈穿支皮瓣的研究進展.中國臨床解剖學雜志, 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. 徐劍,歐陽電.頭頸部惡性外毛根鞘癌的臨床特點及預后分析.吉林醫學, 2014, 35(10) :2079-2081.
2. 張茂紅,杜慶安,李侃.腫瘤整形外科技術在頭皮腫瘤手術中的應用.中國腫瘤外科雜志, 2012, 4(2) :72-75.
3. 袁好軍,安靜,孫宇航,等.帽狀腱膜下筋膜瓣加植皮一期修復頭皮大面積缺損伴顱骨外露.中國美容醫學, 2014, 23(7) :526-528.
4. 葛禮正,劉安軍,郭利剛,等.顳淺動脈及其吻合支為蒂的頭皮瓣在修復頭皮缺損顱骨外露中的臨床應用.中華整形外科雜志, 2014, 30(6) :466-468.
5. 卿勇,岑瑛,王懷勝,等.頭皮惡性腫瘤外科切除后的修復.中國修復重建外科雜志, 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. 鮑世威,馬小兵,趙紅藝,等.游離肩胛皮瓣移植修復頭皮大面積缺損合并骨外露.中國組織工程研究, 2014, 18(51) :8315-8319.
8. 朱薛鋒,鄧景成,蔣朝華,等.頭皮撕脫傷顯微外科再植的急救處理.組織工程與重建外科雜志, 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. 湯海萍,騰國棟,姜凱.游離皮瓣在顱骨外露的頭皮缺損中的應用.中國美容醫學, 2013, 22(4) :431-433.
11. 王煒,李華.游離股前外側皮瓣一期修復頭皮鱗狀細胞癌術后大面積缺損.實用醫學雜志, 2011, 27(21) :3984-3985.
12. 張萬鋒,梁峰,李金有,等.帶闊筋膜的股前外側穿支組織瓣修復組織缺損.中華燒傷雜志, 2013, 29(5) :427-431.
13. 何永靜,王繼華,楊云,等. CT血管造影在背闊肌皮瓣游離移植修復頭皮撕脫傷創面中的應用.中國修復重建外科雜志, 2013, 27(3) :299-303.
14. 李曉亮,夏成德,狄海萍,等.游離背闊肌皮瓣修復頭部放射性潰瘍一例.中華損傷與修復雜志(電子版), 2014, 9(2) :87-88.
15. 唐舉玉,杜威,宋達疆,等.胸背動脈穿支皮瓣移植修復不同部位皮膚軟組織缺損16例.中華整形外科雜志, 2013, 29(3) :178-180.
16. 杜威.胸背動脈穿支皮瓣的研究進展.中國臨床解剖學雜志, 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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