- 期刊
The Use of Negative Pressure Wound Therapy and Free Flap for Reconstruction of Infected Large Scalp and Cranial Defect with Exposed Dura-A Case Report
使用負壓輔助傷口治療與游離皮瓣於感染性大面積頭皮及顱骨缺損併硬腦膜外露之重建－病例報告
摘要
背景：感染性大面積頭皮及顱骨缺損併硬腦膜外露之傷口，不僅具有複雜性及對重建手術富有挑戰性，且極可能危及病人生命。雖然負壓輔助傷口治療已用於許許多多複雜的解剖部位，但於感染性大面積頭皮及顱骨缺損併硬腦膜外露中使用負壓輔助傷口治療，文獻中病例報告仍然不多見。目的和目標：介紹負壓輔助傷口治療，被應用到感染性大面積頭皮及顱骨缺損併硬腦膜外露之感染控制及保護外露的硬腦膜之重要解剖結構，以防止硬腦膜脫水乾枯；且其主要目標，更是為能夠建立一個接續的植皮或皮瓣重建手術而準備之傷口床。材料和方法：我們的病人為一名63歲外傷性腦損傷昏迷的女性病患，並有糖尿病病史；因其左側顳頂葉頭皮術後壞死及顱內傷口感染，而由外院轉入本院治療。經過三個星期的積極清創及負壓輔助傷口治療，保護重要結構的硬腦膜。其傷口床顯示在硬腦膜上覆蓋一層新鮮且厚的肉芽組織形成，接續再以游離橈側前臂皮瓣重建大面積頭皮及顱骨缺損缺損。結果：經過三個星期之術後照顧，游離橈側前臂皮瓣成功存活及傷口痊癒，傷口並沒有任何感染的跡象發生。隨後，病人腦積水問題，由腦神經外科醫師執行腦室-腹腔分流安置減壓手術，病患安全出院。結論：負壓輔助傷口治療應用於感染性大面積頭皮及顱骨缺損併硬腦膜外露之感染控制及保護外露的硬腦膜之重要解剖結構，可以提供安全、可行、有效及可靠的輔助傷口治療及且為重建之傷口床舖路準備；但其缺點必須接受多次全身麻醉與更換抽吸海綿及清創手術以控制感染及皮瓣重建。
關鍵字
無資料並列摘要
Background: Infected large cranial defect with exposed dura is not only a complicating and challenging problem wound for plastic and reconstructive surgery, but it is also a life threatening condition. Although Vacuum-assisted wound closure (VAC) has been used for many complicated anatomic areas, there are still very few case reports for using VAC in large cranial defect with exposed dura followed by wound reconstruction. Aim and Objectives: In the case presented, the negative pressure wound therapy was applied on the infected large cranial defect with exposed dura for control infection and protection of the vital structure to prevent dural desiccation, and also for wound bed preparation, followed by skin graft or flap reconstruction. Materials and Methods: A 63-year-old unconscious woman, who has a medical history of diabetes mellitus, was referred to our institute for management of necrosis of left temporo-parietal scalp and intracranial wound infection caused by cranioplasty, following decompressive craniectomy for traumatic brain injury. After aggressive debridement and irrigation, the topical negative pressure wound therapy was applied to protect the vital structure of the dura. After three weeks, the wound showed a thick fresh granulation tissue bed formation overlying the exposed dura for preparing followed by skin graft or flap reconstruction. Reconstruction was performed with a free radial forearm flap to cover the large cranial defect of left temporoparietal area. 190 Reconstruction of Infected Large Scalp and Cranial Defect with Exposed Dura Results: The flap healed primarily, and the wound presented without any signs of infection. Complete wound healing of left temporoparietal area was achieved after 3 weeks. Subsequently, the patient underwent V-P shunt placement via right Frazier's point approach for drainage of hydrocephalus. After 2-month post-operative follow-up, the wound showed good result without any complications. Conclusion: The negative pressure wound therapy could offer a safe, feasible, effective and reliable adjunct in the therapy of intracranial wound infection with large cranial defect and exposed dura for wound bed preparation, followed by skin graft or flap reconstruction. However, the major disadvantage is the necessity for four or more operations.