{"created":"2024-02-13T01:28:45.603608+00:00","id":2000789,"links":{},"metadata":{"_buckets":{"deposit":"87c79398-b9d9-4f2b-8281-bc4cae99ae63"},"_deposit":{"created_by":17,"id":"2000789","owner":"17","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"2000789"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:02000789","sets":["29:31:1706669033099:1706669223536"]},"author_link":[],"control_number":"2000789","item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Three cases of scalp reconstruction with free latissimus dorsi myocutaneous flap for intractable scalp ulcer after craniotomy","subitem_alternative_title_language":"en"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"カイトウ ジュツゴ ノ ナンチセイ トウブ ヒフ カイヨウ ニ タイシテ ユウリ コウハイキン ヒベン ニ ヨル トウヒ サイケン オ シコウ シタ ３レイ","subitem_alternative_title_language":"ja-Kana"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2024-02-21","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"89","bibliographicPageStart":"83","bibliographicVolumeNumber":"42","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学","bibliographic_titleLang":"ja"},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article)","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"【背景】　開頭術後の皮膚潰瘍・瘻孔は難治性であることが多く、特に広範な欠損や感染を伴う場合には脳神経外科単独ではその治療に難渋する。開頭術後の難治性頭部皮膚潰瘍に対して、形成外科と合同で遊離広背筋皮弁による頭皮再建を施行し治癒が得られた3例を経験したため報告する。\n【症例】　2例は30年以上前に脳腫瘍摘出術と術後照射を受けた53歳男性（症例1）と59歳男性（症例3）、もう1例は7年前に巨大内頚動脈瘤に対するhigh flow bypass（vein graft）と内頚動脈結紮術を受け、その後創感染から骨弁除去、さらに人工骨による頭蓋形成術を受けた64歳女性（症例2）。症例1, 3は頭皮弁中心部の潰瘍形成と排膿を認め、症例2は創癒合不全から創離開が拡大し人工骨が広く露出した状態であった。全例、遊離広背筋皮弁を用いて再建を行った。手術では、潰瘍部と周囲の色調不良な皮膚を切除し、骨弁除去後の死腔に筋弁を充填、頭皮と皮島を縫合し閉鎖した。吻合血管は2例が顔面動静脈、1例が浅側頭動脈と中側頭静脈とした。皮弁阻血時間は2時間31分から3時間14分で、血流再開後の皮弁の色調は良好であった。全例、創感染の再燃や皮弁のトラブルなく良好に経過している。\n【考察】　創感染と頭皮弁の菲薄化などが原因で生じる開頭術後の皮膚潰瘍・瘻孔は難治性であり、その治療には骨弁・異物の除去とデブリードマン、頭皮欠損部の再建が必要となる。今回の3症例はいずれも難治性であり、根治的治療が必要であった。今回用いた遊離広背筋皮弁は、簡便かつ短時間で挙上可能、充分な筋体確保、採取後の機能障害が少ないなど多くの利点がある。欠損部位の状態に応じた適切な再建法を選択することで、難治性の症例でも治癒が得られることを経験した。\n【結論】　遊離広背筋皮弁による頭皮再建が、開頭術後の難治性頭部皮膚潰瘍に対して有用であった。遊離皮弁を用いた皮膚軟部組織再建では、症例毎に適切な再建法を選択する必要があり、形成外科の協力が必要不可欠である。","subitem_description_language":"ja","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"names":[{"name":"ヤマダ,ユウキ","nameLang":"ja-Kana"}]},{"names":[{"name":"イガラシ,コウヘイ","nameLang":"ja-Kana"}]},{"names":[{"name":"ホンマ,ヒロシ","nameLang":"ja-Kana"}]},{"names":[{"name":"イタガキ,ヒロシ","nameLang":"ja-Kana"}]},{"names":[{"name":"サトウ,シンジ","nameLang":"ja-Kana"}]},{"names":[{"name":"コクボ,ヤスアキ","nameLang":"ja-Kana"}]},{"names":[{"name":"カン,タケシ","nameLang":"ja-Kana"}]},{"names":[{"name":"ヤノ,アキコ","nameLang":"ja-Kana"}]},{"names":[{"name":"フクダ,ノリコ","nameLang":"ja-Kana"}]},{"names":[{"name":"ソノダ,ユキヒコ","nameLang":"ja-Kana"}]}]},"item_3_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"names":[{"name":"Yuuki,Yamada","nameLang":"en"}]},{"names":[{"name":"Kohei,Igarashi","nameLang":"en"}]},{"names":[{"name":"Hiroshi,Honma","nameLang":"en"}]},{"names":[{"name":"Hiroshi,Itagaki","nameLang":"en"}]},{"names":[{"name":"Shinji,Sato","nameLang":"en"}]},{"names":[{"name":"Yasuaki,Kokubo","nameLang":"en"}]},{"names":[{"name":"Takeshi,Kan","nameLang":"en"}]},{"names":[{"name":"Akiko,Yano","nameLang":"en"}]},{"names":[{"name":"Norio,Fukuda","nameLang":"en"}]},{"names":[{"name":"Yukihiko,Sonoda","nameLang":"en"}]}]},"item_3_identifier_registration":{"attribute_name":"ID登録","attribute_value_mlt":[{"subitem_identifier_reg_text":"10.15022/0002000789","subitem_identifier_reg_type":"JaLC"}]},"item_3_publisher_32":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"山形大学","subitem_publisher_language":"ja"}]},"item_3_source_id_7":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0288-030X","subitem_source_identifier_type":"ISSN"}]},"item_3_source_id_9":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN00067279","subitem_source_identifier_type":"NCID"}]},"item_3_text_33":{"attribute_name":"出版者（ヨミ）","attribute_value_mlt":[{"subitem_text_language":"ja-Kana","subitem_text_value":"ヤマガタ ダイガク"}]},"item_3_text_34":{"attribute_name":"別言語の出版者","attribute_value_mlt":[{"subitem_text_language":"en","subitem_text_value":"Yamagata University"}]},"item_3_text_43":{"attribute_name":"資源タイプ・ローカル","attribute_value_mlt":[{"subitem_text_value":"紀要論文"}]},"item_3_text_44":{"attribute_name":"資源タイプ・NII","attribute_value_mlt":[{"subitem_text_value":"Departmental Bulletin 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scalp ulcer","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"craniotomy","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"infection","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"departmental bulletin paper","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"開頭術後の難治性頭部皮膚潰瘍に対して遊離広背筋皮弁による 頭皮再建を施行した3例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"開頭術後の難治性頭部皮膚潰瘍に対して遊離広背筋皮弁による 頭皮再建を施行した3例","subitem_title_language":"ja"}]},"item_type_id":"3","owner":"17","path":["1706669223536"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2024-02-21"},"publish_date":"2024-02-21","publish_status":"0","recid":"2000789","relation_version_is_last":true,"title":["開頭術後の難治性頭部皮膚潰瘍に対して遊離広背筋皮弁による 頭皮再建を施行した3例"],"weko_creator_id":"17","weko_shared_id":-1},"updated":"2024-04-11T05:03:05.361860+00:00"}