A 15-year Experience of Complex Scalp Reconstruction Using Free Tissue Transfer—Analysis of Risk Factors for Complications

Fischer, John P.; Sieber, Brady A.; Nelson, Jonas A.; Kovach, Stephen J.; Taylor, Jesse A.; Serletti, Joseph M.; Wu, Liza C.; Kanchwala, Suhail; Bartlett, Scott P.; Low, David W.

doi:10.1055/s-0032-1329918

Cited by 23 publications

(34 citation statements)

References 21 publications

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“…Myocutaneous flaps tended to have higher complications than myofascial in this study population. Chao et al [42] , in a study of 48 scalp reconstructions involving concurrent cranioplasty found no difference in postoperative outcomes between myofascial and fasciocutaneous/myocutaneous free flap reconstruction. Uzun et al [47] , when examining 21 free flap reconstructions for cranioplasty coverage, found no difference in postoperative outcomes between fasciocutaneous and myocutaneous free tissue transfer, although the former had the benefits of shorter hospitalization and lower rates of tissue atrophy.…”

Section: Free Tissue Transfer and 3d Modelingmentioning

confidence: 96%

“…The pliability and thickness of the transplanted tissue allow it to contour to the underlying tissue and withstand postoperative radiation with reduced risk of wound healing complications [11] . Success rates of free tissue transfer for cranioplasty coverage have been reported over 95%, with well tolerated coverage and acceptable cosmetic results [41][42][43][44] .…”

Section: Free Tissue Transfer and 3d Modelingmentioning

confidence: 99%

“…A variety of free flaps have been described for cranioplasty coverage, performed both as immediate and staged reconstructions [1,[9][10][11]19,21,37,38,[41][42][43][44][45] . These can be categorized as myofascial (latissimus dorsi, anterolateral thigh, and rectus abdominis), myocutaneous (the same flaps harvested with overlying skin), fasciocutaneous (radial forearm, and anterolateral thigh without associated muscle), and osteocutaneous or osteomyocutaneous (osteocutaneous radial forearm, scapular flap, fibular flap, and latissimus dorsi with underlying rib) [Table 1].…”

Section: Free Tissue Transfer and 3d Modelingmentioning

confidence: 99%

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Soft tissue coverage of cranial defects: an update

Lilly¹,

Santucci²,

Petrisor³

et al. 2021

PAR

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Scalp and cranial defects can occur as a result of cutaneous or bony malignancies, trauma, or surgical intervention for intracranial tumors. Soft tissue cranial reconstruction of composite defects presents a unique challenge given the relative tissue inelasticity of the scalp, need for tension free closure, and convex shape of the cranium. An added complexity is found in patients with large defects, cerebrospinal fluid leak, prior failed reconstruction, infection, or previous radiation. Methods and materials for skull reconstruction have evolved significantly over the years, allowing surgeons to repair even the most challenging composite defects with excellent success rates. This review aims to discuss and evaluate the available soft tissue options for cranioplasty coverage, with particular focus on hostile reconstructive fields and the use of free tissue transfer.

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Section: Free Tissue Transfer and 3d Modelingmentioning

confidence: 96%

Section: Free Tissue Transfer and 3d Modelingmentioning

confidence: 99%

Section: Free Tissue Transfer and 3d Modelingmentioning

confidence: 99%

See 1 more Smart Citation

Soft tissue coverage of cranial defects: an update

Lilly¹,

Santucci²,

Petrisor³

et al. 2021

PAR

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“…Reconstruction of scalp defects after resection of cutaneous malignancies can be challenging and requires a considerable degree of surgical planning in order to achieve a satisfactory outcome. Previous studies have developed comprehensive reconstructive algorithms to assist with management of these complex cases [ 1 - 3 ], while other studies have focused on approaches specific to patient risk factors and presentation [ 4 , 5 ]. Advances in microsurgery, a more comprehensive understanding of the anatomical blood supply of the scalp, and the advent of new biologic technologies have all provided the reconstructive surgeon with more tools to combat these defects [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Complex oncologic resection and reconstruction of the scalp: Predictors of morbidity and mortality

Tecce

Othman

Mauch

et al. 2020

Arch Craniofac Surg

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Background: Oncologic resection of the scalp confers several obstacles to the reconstructive surgeon dependent upon patient-specific and wound-specific factors. We aim to describe our experiences with various reconstructive methods, and delineate risk factors for coverage failure and complications in the setting of scalp reconstruction. Methods: A retrospective chart review was conducted, examining patients who underwent resection of fungating scalp tumors with subsequent soft-tissue reconstruction from 2003 to 2019. Patient demographics, wound and oncologic characteristics, treatment modalities, and outcomes were recorded and analyzed. Results: A total of 189 patients were appropriate for inclusion, undergoing a range of reconstructive methods from skin grafting to free flaps. Thirty-three patients (17.5%) underwent preoperative radiation. In all, 48 patients (25.4%) suffered wound site complications, 25 (13.2%) underwent reoperation, and 47 (24.9%) suffered from mortality. Preoperative radiation therapy was an independent risk factor for wound complications (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.1-7.3; p = 0.028) and reoperations (OR, 4.45; 95% CI, 1.5-13.2; p = 0.007). Similarly, the presence of an underlying titanium mesh was an independent predictor of wound complications (OR, 2.49; 95% CI, 1.1-5.6; p = 0.029) and reoperations (OR, 3.40; 95% CI, 1.2-9.7; p = 0.020). Both immunosuppressed status (OR, 2.88; 95% CI, 1.2-7.1; p = 0.021) and preoperative radiation therapy (OR, 3.34; 95% CI, 1.2-9.7; p = 0.022) were risk factors for mortality. Conclusion: Both preoperative radiation and the presence of underlying titanium mesh are independent risk factors for wound site complications and increased reoperation rates following oncologic resection and reconstruction of the scalp. Additionally, preoperative radiation, along with an immunosuppressed state, may predict patient mortality following scalp resection and reconstruction.

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“…Large defects may involve the entire thickness of the soft tissue, or even include calvarial bone and dura mater with cerebrospinal fluid leakage in patients with poor general performance [ 8 , 9 ]. In those cases, chronic soft tissue infection or osteomyelitis often negatively influence the viability of the surrounding tissue and severely limit the use of locoregional flaps for reconstruction [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of composite defects of the scalp and neurocranium—a treatment algorithm from local flaps to combined AV loop free flap reconstruction

et al. 2018

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BackgroundReconstruction of cranial composite defects, including all layers of the scalp and the neurocranium, poses an interdisciplinary challenge. Especially after multiple previous operations and/or radiation therapy, sufficient reconstruction is often only possible using microsurgical free flap transplantation. The aim of this study was to analyze the therapy of interdisciplinary cases with composite defects including the scalp and neurocranium.MethodsFrom 2009 to 2017, 23 patients with 18 free flaps and 10 pedicled/local flaps were analyzed. First choices for free flaps were muscle flaps followed by fasciocutaneous flaps.ResultsExcept for four patients, a stable coverage could be reached in the first operation. Three of these patients received a local scalp rotation flap in the first operation and needed an additional free flap because the local flap was no longer sufficient for coverage after wound healing deficiency or tumor relapse. The superficial temporal artery or external carotid artery served as recipient vessels. In special cases, venous grafts or an arteriovenous loop (AV loop) were used as extensions for the recipient vessels.ConclusionsIn summary, an interdisciplinary approach with radical debridement of infected or necrotic tissue and the reconstruction of the dura mater are essential to reach a stable, long-lasting reconstructive result. Based on our experience, free flaps seem to be the first choice for patients after multiple previous operations and/or radiation therapy.

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A 15-year Experience of Complex Scalp Reconstruction Using Free Tissue Transfer—Analysis of Risk Factors for Complications

Abstract: Prognostic/risk, level III.

Cited by 23 publications

References 21 publications

Soft tissue coverage of cranial defects: an update

Soft tissue coverage of cranial defects: an update

Complex oncologic resection and reconstruction of the scalp: Predictors of morbidity and mortality

Reconstruction of composite defects of the scalp and neurocranium—a treatment algorithm from local flaps to combined AV loop free flap reconstruction

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