title: [Repair of immedicable ulcer in skull cap with expanded bipedical axial flap in senile patients].
abstract: OBJECTIVE
  To investigate the method to repair immedicable ulcer in skull cap in senile patient and the clinical effect of expanded bipedical axial flap in skull cap.
  
  
  METHODS
  From September 2002 to June 2006, 5 patients with immedicable and chronic ulcer in skull cap were treated. All patients were males, aging 55-76 years. Among them, the causes of disease were trauma in 1 case, infection in 1 case, squamous cell carcinoma in 2 cases, and basal cell carcinoma in 1 case. The disease course was 6-25 months. All patients had been treated by 1-4 operations. The area of ulcer ranged from 5 cm x 3 cm to 10 cm x 9 cm. At first stage, soft tissue expander was implanted under the frontal branch of superficial temporal artery and the musculus frontalis according to preoperative design. Then periodic saline injection was carried out after operation. At second stage, the soft tissue expander was taken out. The immedicable ulcer in skull cap was removed, then expanded bipedical axial flap in forehead was designed and transferred to the wound according to the size of the wound. And the donor site was covered with odd expanded flap or split-thickness skin graft. The defect size was 6.0 cm x 3.5 cm to 12.0 cm x 10.5 cm. The size of the flap was from 26 cm x 10 cm to 34 cm x 17 cm.
  
  
  RESULTS
  All the expanded bipedical axial flap survived after operation. The wound had a primary healing. The donor sites healed well. No complications occurred at donor site. All patients were followed up from 3 to 24 months (mean 10 months). No ulcer recurrence and no incompetence in papebral fissure was found. The patients were satisfied with the operation results.
  
  
  CONCLUSIONS
  The satisfactory clinical results are obtained in repairing immedical ulcer in skull cap in old patients by using expanded bipedical axial flap in skull cap. This operation design can be used as a new method to repair immedical ulcer in skull cap in senile patients.
authors.affiliation: Department of Burns and Plastic Surgery, the First Affiliated Hospital of the General Hospital of PLA, Beijing 100037, PR China. wuchen20012001@yahoo.com.cn
authors.forename: Yanqiu
authors.initials: Y
authors.lastname: Wu
authors.forename: Jiake
authors.initials: J
authors.lastname: Chai
authors.forename: Chunming
authors.initials: C
authors.lastname: Liu
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005546:Forehead / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012535:Scalp / Q000293:injuries* / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply*; D015626:Tissue Expansion; D014456:Ulcer / Q000209:etiology / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology