불안정한 생체징후 하의 두피 결출상 환자의 치험례

Treatment of Complete Scalp Avulsion with the Conditions of Unstable Vital Signs: A Case Report

  • 이강우 (경희대학교 의과대학 성형외과학교실) ;
  • 강상윤 (경희대학교 의과대학 성형외과학교실) ;
  • 양원용 (경희대학교 의과대학 성형외과학교실) ;
  • 범진식 (경희대학교 의과대학 성형외과학교실)
  • Lee, Kang Woo (Department of Plastic and Reconstructive Surgery, College of Medicine, Kyung Hee University) ;
  • Kang, Sang Yoon (Department of Plastic and Reconstructive Surgery, College of Medicine, Kyung Hee University) ;
  • Yang, Won Yong (Department of Plastic and Reconstructive Surgery, College of Medicine, Kyung Hee University) ;
  • Burm, Jin Sik (Department of Plastic and Reconstructive Surgery, College of Medicine, Kyung Hee University)
  • 투고 : 2011.05.20
  • 심사 : 2011.08.16
  • 발행 : 2011.11.10

초록

Purpose: Scalp avulsion is a life-threatening injury that may cause trauma to the forehead, eyebrows, and periauricular tissue. It is difficult to treat scalp avulsion as it may lead to severe bleeding. Therefore, emergency scalp replantation surgery is necessary, and we must consider the function, aesthetics, and psychology of the patients. A case of scalp avulsion leading to massive bleeding was encountered by these authors, which led to a failure to achieve the proper operation conditions in an adequate time period. Methods: A 49-year-old female was hospitalized due to having had her head caught in a rotatory machine, causing complete scalp avulsion which included the dorsum of the nose, both eyebrows, and ears. Emergent microsurgical replantation was performed, where a superficial temporal artery and a vein were anastomosed, but the patient's vital signs were too unstable for further operation due to excessive blood loss. Three days after the microanastomosis, venous congestion developed at the replanted scalp, and a medicinal leech was used. Leech therapy resolved the venous congestion. A demarcation then developed between the vitalized scalp tissue and the necrotized area. Debridement was performed 2 times on the necrotized scalp area. Finally, split-thickness skin graft with a dermal acellular matrix ($Matriderm^{(R)}$) was performed on the defective areas, which included the left temporal area, the occipital area, and both eyebrows. Results: The forehead, vertex, right temporal area, and half of the occipital area were successfully replanted, and the hair at the replanted scalp was preserved. As stated above, two-thirds of the scalp survived; the patient could cover the skin graft area with her hair, and could wear a wig. Conclusion: Complete scalp avulsion needs emergent replantation with microsurgical revascularization, but it often leads to serious vital conditions. We report a case with acceptable results, although the microanastomosed vessel was minimal due to the patient's unstable vital signs.

키워드

참고문헌

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