目的 探讨特殊类型老年患者头皮巨大肿瘤切除后大面积缺损的修复方法和经验。方法 本组老年患者共26例，22例患有慢性肺源性心脏病或代谢疾病，身体一般状况较差，4例患有恶性肿瘤。对26例头皮巨大肿瘤进行切除，切除后创面大小10 cm×18 cm～16 cm×24 cm，根据不同的创面特点釆用皮片、轴型皮瓣、扩张皮瓣及游离皮瓣4种不同的方法修复，观察其临床疗效。结果 5例植皮修复创面，2例皮片小部分坏死，随访3例放疗后皮片部分坏死，最终用皮片封闭创面；3例游离皮瓣，2例边缘小部分坏死。1例大部分坏死，创面予皮片修复；5例扩张皮瓣修复创面，3例切口瘢痕较宽，所有老年患者都抱怨治疗的过程太长，扩张器膨胀的过程让其产生不适感；13例轴型皮瓣中1例皮瓣的远端坏死，1例皮瓣切口裂开，移植皮瓣术后放疗未出现坏死。随访3个月～2年，1例肿瘤复发，1例肺癌晚期死亡。结论 对于具有合并症或患恶性肿瘤的特殊老年患者，头皮巨大肿瘤切除后的大面积缺损以轴型皮瓣修复为佳，因其手术瘢痕不明显，皮瓣外观和功能均较满意且治疗时间相对短，可为合并症或者肿瘤的治疗做好准备并赢得宝贵时间。
Objective To investigate the repairing methods and experience of special elderly patients after resection of giant tumors of the scalp defect in large area. Methods The presented study includes 26 patients, 22 cases with chronic pulmonary heart disease or metabolic diseases, with poor general condition, 4 patients with malignancy. After fully excising tumors, the area of the defect ranged from 9 cm×18 cm～16 cm×24 cm, 26 cases were repaired with the skin grafts, axial flaps, expanded flaps and free flaps depending on the wound characteristics. Results 5 cases were performed skin graft, 2 cases of small skin graft necrosis, after radiotherapy 3 cases skin graft necrosis in the following-up, wound closure with skin grafts.3 cases were performed free flaps, 2 cases of partial edge necrosis, 1 case of most necrosis, skin grafts to repair wounds.5 cases were performed expanded flaps, 3 cases of wide incision scar, all complained about the process of treatment was too long, the process of expansion of the stent produced discomfort. 13 cases were performed axial flaps, 1 case of distal flap necrosis, 1 flap incision dehiscence, skin flap did not necrosis after radiotherapy. All cases were followed up for 6 months to 2 years, 1 case of tumor recurrence, 1 case dead for advanced lung cancer. Conclusions For the special elderly patients with comorbidities or malignancy, it is better that large scalp defect after giant tumor resection repaired with axial flap, because surgical scar is not obvious, flaps were satisfactory appearance and function, the treatment time is relatively short, be prepared for treatment of complications or cancer and won valuable time.