Free Pectoralis Major Musculocutaneous Flap for Chronic Osteomyelitis of the Frontal Skull

使用游離皮瓣重建頭顱缺陷，在文獻上已有報告。而對於顱骨的細菌感染合併腦脊髓液由硬腦膜滲出時，若直接縫合硬腦膜常會造成骨髓炎而引起腦膜炎的危險。此時若能利用肌肉皮瓣，不僅提供了良好的覆蓋，且血液循環有助於改善它的感染情況。在此提出一例因為外傷所造成的頭顱缺陷，合併有骨髓炎，結果造成傷口長久不癒。我們採用游離胸大肌皮瓣來重建，結果成功治癒慢性骨髓炎。游離胸大肌皮瓣不僅提供一個良好的覆蓋、而且不必在手術中更換病患的姿勢、它的膚色相容性大、手術過程簡單。胸大肌很少以游離皮瓣的方式轉移，也沒有文獻以此用於重建額骨的缺陷報告，因此為頭顱缺陷的重建提供了另一種選擇。同時本文也比較其他皮瓣的優缺點和文獻回顧。

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並列摘要

The use of free flaps for filling in depressions and defects in the skull region is the subject of this investigation. If there is bacterial colonization of the skull bone with persistent dural leak, treatment with direct dural repair is contraindicated due to the risk of meningitis. A muscular flap provides good blood perfusion which reduces infection, and is useful for the treatment of the chronic osteomyelitis. A large skull bone defect needs adequate coverage. Many muscular flaps have been reported for skull defect reconstruction, but none are available for extensive skull defects and that provide adequate coverage in a one stage reconstruction. We present a 30-year-old male patient with a severe frontal bone fracture and right facial bone deformity from a traffic accident in August, 1996. He received skull bone reconstruction at that time, but the wound became infected and then underwent multiple debridements to remove the sequestrum and epidural abscess. Initially, a free segmental vastus lateralis muscular flap was used to cover the small frontal bone defect, but the wound continued to discharge pus from a fistula. The infection caused shrinkage of the flap which in turn became unable to cover the defect. Wound culture grew oxacillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Working in conjunction with a neurosurgeon, the infected bone was resected and a pectoralis major musculocutaneous flap was placed to cover the large skull defect. The chronic osteomyelitis was thereby cured. Microvascular transfer of a pectoralis major free flap to the skull has not been reported previously in the literature.

並列關鍵字

free pectoralis major musculocutaneous flap ； frontal bone defect ； chronic osteomyelitis

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Free Pectoralis Major Musculocutaneous Flap for Chronic Osteomyelitis of the Frontal Skull

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