摘要目的:探讨显微外科技术进行血管吻合联合美容缝合技术在全头皮撕脱伤原位再植中的临床疗效。方法:回顾性分析2015年1月至2020年12月，北部战区总医院烧伤整形科收治的采用显微外科技术与美容缝合技术联合治疗全头皮撕脱伤患者的临床资料。术中进行彻底清创，对伴有失血性休克的患者给予积极的抗休克治疗，抢救生命。探查血管并进行标记，通过显微外科技术吻合血管，先进行静脉吻合，再根据患者的血管条件进行动脉吻合。术后给予常规抗凝等对症治疗，预防感染，密切观察患者的恢复情况。术后随访观察患者头部轮廓，头皮色泽，通过触觉与压觉等浅感觉检查评估头皮感觉的恢复情况，观察毛发生长状态及有无瘢痕增生。结果:共纳入6例患者，均为女性，年龄36~53岁，均有不同程度的创面污染，其中1例伴有失血性休克。术中2例吻合颞浅静脉、眶上静脉和哨兵静脉，4例吻合颞浅静脉和哨兵静脉；2例吻合颞浅动脉和滑车动脉，4例仅吻合颞浅动脉。患者术后均获3个月至2年随访，平均(13.71 ± 8.98)个月。3例患者原位再植术后成活90%以上，2例成活80%，1例成活75%，坏死部位经刃厚皮片移植修复后成活。再植成活的头皮感觉功能略有减退，毛发能够正常生长，仅留浅表线性瘢痕，患者对治疗效果满意。结论:显微外科技术进行血管吻合联合美容缝合技术进行修复，在全头皮撕脱伤原位再植中可以取得良好的临床疗效。

abstractsObjective:To explore the clinical efficacy of microsurgical technique combined with cosmetic suture technique in situ replantation of total scalp avulsion.Methods:The clinical data of patients with total scalp avulsion admitted to the Department of Burn and Plastic Surgery of General Hospital of Northern Theatre Command from January 2015 to December 2020 were collected. All patients were treated by microsurgical technique combined with cosmetic suture technique. Thorough debridement was performed during the operation. Active anti-shock treatment was given to the patient with hemorrhagic shock. The vascular was explored and labeled. The vascular anastomosis was conducted by microsurgical technique. The venous anastomosis was performed in the first place. The arterial anastomosis was performed according to the patient's condition. Symptomatic treatment, such as routine anti-coagulation, was given to patients after the operation. An infection prevention strategy was performed in patients. The recovery of patients was observed.Results:A total of six patients were involved in this study. All patients were females, aged from 36 to 55 years old. Various degrees of wound contamination can be seen, and one patient with hemorrhagic shock. The superficial temporal vein, supraorbital vein and sentinel vein were anastomosed in two patients, and the superficial temporal vein and sentinel vein were anastomosed in four patients. The superficial temporal artery and supratrochlear artery were anastomosed in two patients, and the superficial temporal artery was anastomosed in four patients. All patients were followed up for 3 months to 2 years, averaging 13.71 months. More than 90% of the scalp survived in three patients, 80% in two patients, and 50% in one patient. The necrotic area survived after replantation of a split-thickness skin graft. The sensory function of surviving scalp after replantation was slightly regressed. The hair growth was normal. Only superficial linear scar left. All patients were satisfied with the efficacy.Conclusions:The application of the microsurgical technique for vascular anastomosis combined with cosmetic suture technique for repair can achieve good clinical efficacy in situ replantation of total scalp avulsion.