頭皮縫縮術における術後瘢痕性脱毛の予防—より効果的な減張切開法—

Prevention of Postoperative Cicatrical Alopecia in the Scalp: More Effective Relaxation Incision

はじめに

　頭皮は厚く可動性と伸展性に乏しいという特殊性があり，単純縫縮では術後に瘢痕性脱毛が問題になることがある。瘢痕性脱毛を防ぐには，緊張のない状態で皮膚縫合を行うことが重要であり，帽状腱膜へ創縁に平行な切開を加え伸展させ，帽状腱膜縫合で創縁を寄せる工夫が報告されている 1）。今回，帽状腱膜に加える切開を工夫することでより大きな伸展が得られ，巨大な病変が帽状腱膜縫合で十分に減張したうえで縫縮可能であったので報告する。

　Excisional suture is a low-invasive method for the reconstruction of scalp defects. Postoperative cicatrical alopecia and a widening scar are serious cosmetic problems, and minimizing the skin tension for a long period is essential to address them. To achieve relaxation of the suture tension in the galea aponeurotica, at our hospital we perform a relaxation incision that is parallel to the flap margin. Of the 56 patients for whom we used scalp excisional sutures in 2022, the skin tension could not be relieved with a conventional parallel incision in six patients. We used a staircase incision instead of the conventional method in these six patients, and in all of their cases the relaxation sutures were sufficient and resulted in no postoperative complication or serious cosmetic issue over a 6-month follow-up period. It is our belief that a staircase incision of the galea aponeurotica is suitable for excisional-suture large scalp defects.