A-T形皮瓣修复头皮缺损.docVIP

A-T形皮瓣修复头皮缺损[摘要]目的：介绍头皮缺损修复的一种方法。 方法：先将缺损修剪成梯形或等腰锐角三角形创面。沿底边向两侧做切口线，长度分别为底边边长的1～2倍；切口线末端各做一个顶与创面方向相反，边长为1～1.5 cm的等腰三角形，以利于皮瓣向创面移动。在帽状腱膜层与颅骨骨膜之间形成皮瓣，向受区推进修复创面。 结果：14例头皮缺损中，面积最小为3cm×3cm，最大为6cm×4cm，全部皮瓣存活良好，创面得以Ⅰ期修复。 结论：A-T形皮瓣制作简单，因该皮瓣的剥离范围广泛，对于皮肤缺乏弹性和活动性的头部来讲，是修复该部位缺损的一种良好方法。 [关键词]A-T形皮瓣；头皮缺损；修复 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2009）01-0024-03 Scalp defects repairing with A-T shaped flap LIU Da-hai, ZHANG Rui,WANG Tao, LUO Yan-jie, ZHOU Yun-xia, YAN Hong (Department of Burned and Plastic Surgery, Panzhihua Center Hospital,Panzhihua 617067, Sichuan,China) Abstract:ObjectiveTo investigate another method to repair scalp defects.MethodsDefects are trimmed into triangular or trapezoidal wound first. Along the base of defect incisions are designed in opposite direction with the length is 1～2 times as long as the boarder, two small triangles with 1～1.5 cm length of waist are designed at the end of incision separately, and the top of the small triangle is opposite direction to the defect. The A-T shaped flap is elevated from superficial fascia layer and advanced from side to middle and closed the focus.ResultsIn 14 cases with scalp defects, the focus area ranged from 3cm×3cm to 6cm×4cm, all flaps survived with primary healing postoperation.ConclusionThe elevating of A-T shaped flap is easy. Because this flap can be dissected extensively and scalp is lack of elasticity and activity, undoubtedly it is a good method for repair of scalp defects which can not be sutured directly. Key words：A-T shaped flap;scalp defects; repairing 自2006年2月至2008年6月，笔者应用A-T形皮瓣修复头皮缺损14例，所有皮瓣均Ⅰ期存活，无坏死及切口裂开，现做如下介绍。 1手术方法 1.1皮瓣设计：切除病灶后，将创面或原发性缺损修剪成锐角的等腰三角形或梯形或“子弹头”形，如图1A所示ABC形状。创面的修剪有一定经验可循：顶部的圆形创面修剪时，三角形尖端应朝前，枕部创面修剪时三角形尖端应朝后；因皮瓣形成后需做大范围剥离，枕后区有较厚的枕肌附丽，剥离时出血较多。椭圆形创面则以长轴为三角形的高来做修剪。三角形的底边的延长线（皮瓣切口线）尽可能避开无发区，否则切口线外露，影响美观。以修剪后的缺损底边为轴设计皮瓣，步骤如下：①由三角形底边向两侧做切口线至D、E两点，DB与CE的长度大致为缺损底边BC长度的1～2倍，据不同情况DB、CE线可为直线，或弧线或沿发际区等走行；②切口线两端做一回切的等腰小三角形来消除皮瓣移位后形成的“猫耳”，三角形底宽约1cm，腰长约1.5cm。注意三角形尖端须与