- 期刊
Temporal Scalp and Lateral Forehead Reconstruction with Combined Occipital Rotational Flap, Artificial Dermal Graft and Skin Grafting-Case Report and Literature Review
使用人工真皮合併顳枕旋轉皮瓣重建顳部頭皮前額缺損──個案報告及文獻回顧
摘要
Background: Scalp and forehead reconstructions present a significant challenge regardless of the cause of the defect. Different reconstruction methods, including skin graft, local flap, rotational flap, free flap, and artificial dermis, are available depending on the clinical situation. Aims and Objectives: This article aims to present a case of a patient who underwent ablative surgery for cancer, resulting in defects involving the temporal scalp and lateral forehead hairline. We will discuss the reconstruction procedure, which involved a combination of a rotational occipital flap, artificial dermal graft, and skin grafting. Materials and Methods: We describe the case of a 45-year-old male with dermatofibrosarcoma protuberans located on the left temporal scalp and lateral forehead. The patient received modified Mohs surgery wide excision. The tumor had affected the hairline and scalp on the left temporal side. An occipital rotational flap was used to cover hair-bearing areas on the temporal scalp, while an artificial dermis and skin graft were utilized to cover the hairless lateral forehead defects. Results: The wound healed successfully, and the hairline was restored. The specimen was margin-free according to pathology results. Conclusion: Complex reconstructions of the forehead and scalp require careful consideration of both hair-bearing tissue and cosmetic outcomes. Our findings suggest that combining local flaps, artificial dermal graft, and skin grafting is a viable alternative for oncological tumor reconstruction, particularly when the defect involves the hairline and requires careful consideration of cosmetic outcomes.
並列摘要
背景：頭皮前額由於區域的關係對重建是一項挑戰。重建的方式取決於缺損的位置、大小和深度。植皮、局部皮瓣、旋轉皮瓣、自由皮瓣及人工真皮均是頭皮重建的選擇。局部皮瓣可重建的區域因位於頭皮而有所限制。另外，有髮區及無毛髮區作為美觀因素也應納為重建的考量之一。目的及目標：我們使用旋轉枕骨皮瓣和人工真皮移植重建廣泛切除術後的顳部頭皮和外側前額缺損。根據髮線決定旋轉枕骨皮瓣覆蓋範圍。使用人工真皮重建無毛髮區。材料及方法：一名45歲男性因隆突性皮膚纖維肉瘤（DFSP）侵犯左顳側頭皮和前額外側區域。我們設計調整型莫氏手術。經過廣泛切除後病人有左顳及左前額缺損併頭骨外露。我們使用旋轉枕部皮瓣重建有髮區，並使用人工真皮重建前額無毛髮區。經過3週人工真皮穩定後植皮在人工真皮區域。植皮長入（take）人工真皮率高。結果：經過二年追蹤，前額外側無毛髮區人工真皮植皮術後傷口癒合良好，旋轉皮瓣重建有髮區頭髮生長正常。兩年內的追蹤腫瘤無復發。結論：複雜的前額頭皮缺損的重建有傷口癒合及外觀對稱性考量。我們提出使用枕部旋轉皮瓣重建有毛髮的頭皮，並使用人造真皮重建前額非毛髮區域，以達到外觀對稱性需求。人工真皮用於需要自由皮瓣重建的區域，不只可以減少自由皮瓣供區的犧牲（donor site morbidity），也可以減少對病人的負擔。結合旋轉皮瓣和人工真皮重建是一種可行的替代自由皮瓣的頭皮重建方法，尤其在缺損涉及髮線有美觀考量時。