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The Utility of the Galea in scalp Reconstruction

Modern Plastic Surgery 2023年第1期13卷 16-22页

作者： Jack D. Sudduth John M. Sullivan Marc E. Walker Division of Plastic and Reconstructive Surgery Department of Surgery University of Mississippi Medical Center Jackson MS USA

Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, treatments evolved to scalp replantation, becoming the standard of care in scalp reconstruction. Although the integrity of the scalp’s blood vessels is pivotal for successful replantation, the authors believe that scalp replantation should be considered at all costs. In the presented case, a 54-year-old female presented to the emergency room following an incident with an auger that completely avulsed her scalp. She was taken back to the operating room, where scalp replantation was performed. Following replantation, scalp necrosis led to serial debridings in the operating room, and eventually, all of the scalp was debrided down to healthy tissue. Surprisingly, the galea survived despite this, which provided a healthy base for skin grafts. Before definitive coverage was placed, it was decided to utilize a bilaminar acellular dermal matrix along with negative pressure wound therapy to create a more robust bed of granulation tissue. After three weeks of this treatment plan, the patient returned to the operating room, where a healthy, viable bed of granulating tissue was revealed beneath the dermal matrix. Split-thickness skin grafts were taken from her thighs bilaterally and sewn together in a quilt-like fashion to cover the wound bed. The entirety of the graft healed without complication except for one small area that required full-thickness skin grafting in an outpatient setting. Even though the replantation ultimately failed, it allowed the galea to survive, which saved the patient from undergoing a free tissue transfer and allowed her scalp to be reconstructed with split-thickness skin grafts. Even in the setting of polytrauma, the authors hope that anyone treating a scalp avulsion would consider scalp replantation at all costs.

关键词： scalp Reconstruction scalp replantation Failed replantation Galea Polytrauma Split-Thickness Skin Grafts Bilaminar Acellular Dermal Matrix

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吻合血管的撕脱头皮回植21例

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中华烧伤杂志 1997年第6期 435-438页

作者：周苏程开祥王善良董佳生黄文义张涤生上海第二医科大学附属第九人民医院整复外科

报告了21例吻合血管的头皮再植,其中全头皮撕脱20例,小块头皮撕脱1例,头皮离体时间3～13小时。在全头皮撕脱中有3例为多块头皮撕裂。21例头皮再植除1例失败外均获成功。文中详细介绍了头皮再植的手术方法,手术适应证,术后并发症及其处... 详细信息

报告了21例吻合血管的头皮再植,其中全头皮撕脱20例,小块头皮撕脱1例,头皮离体时间3～13小时。在全头皮撕脱中有3例为多块头皮撕裂。21例头皮再植除1例失败外均获成功。文中详细介绍了头皮再植的手术方法,手术适应证,术后并发症及其处理原则。提出了撕脱头皮常有不同程度的挫伤,主张吻合双侧动静脉是非常必要的,动静脉吻合比例可按1:1。认为头皮再植是头皮撕脱伤病人的最佳治疗方法。

关键词： Vascular anastomosis scalp replantation Avulsecl scalp

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