Salvage of Methylmethacrylate Cranioplasty with Advancement Scalp Flap and Hyperbaric Oxygen Therapy-A Case Report

以頭皮皮瓣及高壓氧治療因異丁烯酸甲酯骨泥顱骨整形術產生之併發症－一病例報告

邱大睿(Ta-Jui Chiu) ； 張世幸(Shih-Hsin Chang) ； 董光義(Kwan-Yi Tung) ； 蕭弘道(Hung-Tao Hsiao)

《中華民國整形外科醫學會雜誌》 18卷3期 (2009/09) Pp. 295-300

https://doi.org/10.7096/JPSA.200909.0295

摘要

背景：
利用異丁烯酸甲酯骨泥作為顱骨整形術是一常見的手術。但是術後仍有可能產生頭皮全層壞死與骨泥暴露的嚴重併發症。此時重建傷口是必要的。
目的與目標：
全層頭皮缺損與骨泥暴露需要皮瓣來作重建。若以頭皮皮瓣重建可得到最好之美觀效果。
材料與方法：
病患接受異丁烯酸甲酯骨泥顱骨整形術，術後發生10×6公分全層頭皮壞死與骨泥暴露。我們利用傷口周圍之健康頭皮作盔層下(subgalea)之撥離，並將翻起之頭皮皮瓣作盔層刻劃(galeal scoring)，於是此頭皮缺損可作直接關閉。手術後，因原傷口旁之自由皮瓣發生缺氧狀況。我們利用高壓氧輔助治療以挽救此皮瓣。
結果：
我們成功的以一次性手術用鄰近頭皮皮瓣將此缺損重建。而高壓氧輔助治療也成功的挽救缺氧狀況的皮瓣。
結論：
以頭皮作盔層下撥離與盔層刻劃可用來重建中度範圍之頭皮全層缺損。手術後美觀效果良好。

並列摘要

Background:
The use of methylmethacrylate for cranioplasty is a common operation. It is possible to cause serious complications, such as scalp necrosis and methylmethacrylate plate exposure. If the complication occurred, reconstruction of the wound was necessary.
Aim and Objectives:
Using flaps to cover the wound with whole-layered scalp defect and methylmethacrylate exposure is necessary. The best replacement for scalp tissue is scalp tissue itself.
Materials and Methods:
The patient received cranioplasty because of skull defect and contour deformity. After the operation, a 10×6 cm, whole-layeres scalp necrosis and methylmethacrylate exposure was noted. The wound was successfully closed by scalp advancement flap with galeal scoring. After closing the defect, ischemia of the previous free flap aside the wound was noted. Hyperbaric oxygen therapy was applied to salvage the flap.
Result:
We successfully reconstructed the defect by one-staged scalp advancement flap. Besides, the ischemic flap was salvaged by HBO therapy.
Conclusion:
By scalp advancement flap and galeal scoring, moderate sized scalp defect can be closed directly. The cosmetic result is acceptable.

並列關鍵字

methylmethcrylate cranioplasty ； scalp reconstruction ； galeal scoring scalp flap ； HBO therapy for flap salvage