皮肤软组织扩张术在头皮神经纤维瘤治疗中的应用(1)
[摘要]目的：探讨皮肤软组织扩张术在头皮神经纤维瘤治疗中的应用效果。方法：回顾性分析2015年1月-2018年12月笔者科室应用皮肤软组织扩张术治疗的12例头皮神经纤维瘤患者。根据肿瘤的部位和面积、二期手术皮瓣转移的方式、头皮血供分布，在瘤体旁正常头皮内置入扩张器。定期注水扩张，至满足修复需求的容量，二期手术切除肿瘤，扩张皮瓣覆盖创面。对于巨大的肿瘤，可多次接力扩张。结果：12例头皮神经纤维瘤患者进行15个周期的扩张治疗，二期手术后肿瘤均成功切除，皮瓣全部成活，切口愈合良好。2例患者出现皮瓣下血肿，经穿刺抽血、加压包扎后治愈。随访1～6个月，肿瘤无原位复发，患者外观满意。结论：对于不超过头皮面积1/2的中小面积头皮神经纤维瘤，皮肤软组织扩张术治疗能获得优良效果。
[关键词]神经纤维瘤;软组织扩张术;扩张器;头皮;扩张皮瓣;创面修复;介入栓塞
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2019)11-0001-03
Abstract： Objective To investigate the application of skin soft tissue expansion in the treatment of scalp neurofibroma. Methods A retrospective analysis was performed on twelve cases of scalp neurofibromas treated by skin and soft tissue expandor in our department from January 2015 to December 2018. According to the location and area of the tumor， the transfer of expanded flap in the second-stage operation， and the distribution of blood vessels in the scalp， an expandor with suitable volume was implanted in the normal scalp adjacent to the tumor. Regular water injection was carried out for expansion until the need of expanded skin for the repair was met. Then tumor was removed and the expanded skin flap was transferred to cover the wound. As to giant tumors， it was feasible to employ multiple expansions. Results Twelve patients were treated with 15 cycles of dilatation， all the tumors were successfully resected， all the flaps survived and the incision healed well after the second stage operation. Two patients presented with subcutaneous hematoma， which was cured by puncture blood drawing and pressure dressing. The patients were followed up for 1 to 6 months. The appearance was satisfying. Conclusion Regarding to scalp neurofibroma with small to medium area， which does not exceed 1/2 of the scalp area， excellent results can be obtained by skin and soft tissue expansion.
Key words： neurofibroma; soft tissue expansion; expander; scalp; expanded skin flap; wound repair; interventional embolization
頭皮神经纤维瘤因位置特殊、体积巨大而面临术中出血多、修复难度大等问题[1]。而使用皮肤扩张术能获得足以覆盖创面的保留原有组织细胞特性的新生组织细胞，是目前外科领域修复软组织缺损最为理想的方式[2]。应用扩张头皮瓣修复头皮缺损还能避免游离皮片移植、无毛发区皮瓣转移等修复方式造成的秃发畸形，获得良好疗效。笔者科室2015年1月-2018年12月应用皮肤软组织扩张术治疗头皮神经纤维瘤12例患者，现报道如下。
1 资料和方法
1.1 一般资料：2015年1月-2018年12月，笔者科室收治12例头部神经纤维瘤患者，男7例，女5例，年龄12～61岁;其中单发肿瘤9例，I型神经纤维瘤病3例;神经纤维瘤面积28～204cm2。
1.2 手术方法
1.2.1 一期手术：麻醉后常规消毒铺巾，美蓝在头皮标记皮肤软组织扩张器埋置范围。在瘤体和正常头皮的边缘作V形切口，尖端指向病灶侧，切开肿瘤周围正常皮肤，钝性分离皮下组织至帽状腱膜下层，按标记范围分离帽状腱膜下层形成囊腔，范围略超出扩张器边缘。谨慎止血后埋置展平的圆柱形扩张器，注射壶外置用于引流，逐层缝合。1周后开始注水，每周注水2次，视患者耐受情况决定单次注水量，每次5～20ml，注水时观察毛细血管反应，6～10周完成扩张过程。, 百拇医药(韩钰钰 徐媛 王慜)
[关键词]神经纤维瘤;软组织扩张术;扩张器;头皮;扩张皮瓣;创面修复;介入栓塞
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2019)11-0001-03
Abstract： Objective To investigate the application of skin soft tissue expansion in the treatment of scalp neurofibroma. Methods A retrospective analysis was performed on twelve cases of scalp neurofibromas treated by skin and soft tissue expandor in our department from January 2015 to December 2018. According to the location and area of the tumor， the transfer of expanded flap in the second-stage operation， and the distribution of blood vessels in the scalp， an expandor with suitable volume was implanted in the normal scalp adjacent to the tumor. Regular water injection was carried out for expansion until the need of expanded skin for the repair was met. Then tumor was removed and the expanded skin flap was transferred to cover the wound. As to giant tumors， it was feasible to employ multiple expansions. Results Twelve patients were treated with 15 cycles of dilatation， all the tumors were successfully resected， all the flaps survived and the incision healed well after the second stage operation. Two patients presented with subcutaneous hematoma， which was cured by puncture blood drawing and pressure dressing. The patients were followed up for 1 to 6 months. The appearance was satisfying. Conclusion Regarding to scalp neurofibroma with small to medium area， which does not exceed 1/2 of the scalp area， excellent results can be obtained by skin and soft tissue expansion.
Key words： neurofibroma; soft tissue expansion; expander; scalp; expanded skin flap; wound repair; interventional embolization
頭皮神经纤维瘤因位置特殊、体积巨大而面临术中出血多、修复难度大等问题[1]。而使用皮肤扩张术能获得足以覆盖创面的保留原有组织细胞特性的新生组织细胞，是目前外科领域修复软组织缺损最为理想的方式[2]。应用扩张头皮瓣修复头皮缺损还能避免游离皮片移植、无毛发区皮瓣转移等修复方式造成的秃发畸形，获得良好疗效。笔者科室2015年1月-2018年12月应用皮肤软组织扩张术治疗头皮神经纤维瘤12例患者，现报道如下。
1 资料和方法
1.1 一般资料：2015年1月-2018年12月，笔者科室收治12例头部神经纤维瘤患者，男7例，女5例，年龄12～61岁;其中单发肿瘤9例，I型神经纤维瘤病3例;神经纤维瘤面积28～204cm2。
1.2 手术方法
1.2.1 一期手术：麻醉后常规消毒铺巾，美蓝在头皮标记皮肤软组织扩张器埋置范围。在瘤体和正常头皮的边缘作V形切口，尖端指向病灶侧，切开肿瘤周围正常皮肤，钝性分离皮下组织至帽状腱膜下层，按标记范围分离帽状腱膜下层形成囊腔，范围略超出扩张器边缘。谨慎止血后埋置展平的圆柱形扩张器，注射壶外置用于引流，逐层缝合。1周后开始注水，每周注水2次，视患者耐受情况决定单次注水量，每次5～20ml，注水时观察毛细血管反应，6～10周完成扩张过程。, 百拇医药(韩钰钰 徐媛 王慜)