ABSTRACT
It is difficult to repair large skull and dural defects. We observed the therapeutic effects of anterolateral thigh flaps with vascular fascia lata for repairing large skull and dural defects.From December 2008 to June 2019, we repaired large skull and dural defects for 28 cases including 12 cases with scalp malignant tumor and 16 cases requiring removal of titanium mesh which had been once placed due to craniocerebral trauma. The scalp malignant tumor invaded full-thickness skull in 12 cases; and invaded cervical lymph nodes, dura mater or brain tissue in 3 cases. In the 12 cases with scalp malignant tumor, the scalp defects of 12âcmâ×â9âcm to 22âcmâ×â18âcm and skull defects of 9 cmâ×â7 cm to 15 cmâ×â12âcm after radical tumor resection were repaired using anterolateral thigh flaps of 14 cmâ×â11 cm to 23 cmâ×â19âcm with fascia lata of 10 cmâ×â8âcm to 16 cmâ×â12âcm. Postoperative radiotherapy and chemotherapy were also performed in the 3 cases with tumor metastasis. In the 16 cases requiring removal of titanium mesh, the skull and dural defects of 8 cmâ×â7 cm to 15 cmâ×â11âcm after removal of titanium mesh were repaired using anterolateral thigh flaps of 10 cmâ×â8 cm to 16 cmâ×â12âcm.In all cases, the transplanted anterolateral thigh flap with fascia lata survived after surgery and no vascular crisis occurred. During the followup of 8 months to 9 years, the flap appearance in the head-repaired area was fine, no external hernia of brain tissue occurred, the appearance of the femoral donor site was acceptable, and femoral muscle strength and movements were normal in all cases. The 12 cases with scalp malignant tumor had no local recurrence or distant metastasis.Repairing the skull and dural defects caused by radical surgery for scalp malignant tumor or removal of titanium mesh using anterolateral thigh flaps with vascular fascia lata, is effective. The appearance in the head-repaired area is fine without external hernia of brain tissue.
Subject(s)
Dura Mater/surgery , Plastic Surgery Procedures/methods , Skull/surgery , Surgical Flaps/transplantation , Thigh/surgery , Adult , Aged , Brain Injuries/surgery , Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/surgery , Dura Mater/injuries , Female , Head and Neck Neoplasms/surgery , Humans , Male , Middle Aged , Scalp/surgery , Skin Neoplasms/surgery , Skull/injuries , Surgical Mesh , Titanium , Young AdultABSTRACT
It is difficult to repair knee deep burn wounds in elderly patients. In this study, we observed the therapeutic effects of descending genicular artery-saphenous artery perforator flaps on knee deep burn wounds in elderly patients.Between December 2013 and February 2018, we repaired knee third-degree burn wounds using descending genicular artery-saphenous artery perforator flaps of 20â×â12âcm to 23â×â13âcm in 56 elderly patients. For the patella and patellar ligament with complete necrosis, the patella and patellar ligament were completely removed, whereas for the patella and patellar ligament with partial necrosis, necrotic parts were removed first. The donor area was repaired using intermediate thickness free skin graft. The 56 patients were 76- to 85 years' old and all had unilateral knee burn.All flaps survived in the 56 patients. After the follow-up of 2 to 36 months, the flaps were excellent in texture and appearance, and exhibited sensory recovery. In the 8 patients with completely necrotic patella and patellar ligament as well as open knee joint, the weight-bearing function of knee joint was retained, which met patients' requirements of limb salvage and weight-bearing function. In the other 48 patients with partially necrotic patella and patellar ligament as well as open joint capsule, the postoperative flexion and extension of the knee joint were good.In elderly patients, it is an effective method to repair knee deep burn wounds using the descending genicular artery-saphenous artery perforator flaps.
