Complications after oncologic scalp reconstruction: A 139-patient series and treatment algorithm

Janus, Jeffrey R.; Peck, Brandon W.; Tombers, Nicole M.; Price, Daniel L.; Moore, Eric J.

doi:10.1002/lary.24855

Cited by 32 publications

(25 citation statements)

References 30 publications

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“…3). Thus, in consideration of the risk profile that accompanies preoperative radiation as discussed above, patients should be thoroughly counseled regarding the risk benefit ratio, and consideration should be given to reconstruct large radiated defects with free flaps in order to provide additional healthy soft-tissue bulk [10,21]. Our preferred approach is for formal surgical resection until negative margins are achieved and confirmed by pathological analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Wide-surgical excision, irradiated and fibrotic native tissue, and prior reconstructive efforts may all limit the options available for definitive coverage [9]. Additionally, radiation to fungating lesions can result in the development of a wound from tumor necrosis that may be very challenging to heal in the radiated field [10]. An additional complicating factor is that patients present for reconstructive consultation with a variety of treatment histories, including before or after radiation therapy, past surgical excision, and prior reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…A detailed understanding of scalp anatomy and perfusion, as well as the quality of the soft tissue, is critical for sufficient reconstruction [ 22 , 23 ]. It should be distinguished between small (< 10 cm 2 ) and moderately (10–50 cm 2 ) sized defects in patients with good general health where full closure is achieved easily and esthetic aspects (e.g., eyebrow symmetry, hairline, avoidance of alopecia) are the challenge in those cases [ 6 ] and large defects (> 50 cm 2 ) in patients with poor general performance status where complete per se closure is the primary goal [ 3 , 24 ].…”

Section: Discussionmentioning

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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“…Há inúmeras técnicas para reconstrução do couro cabeludo. Enxerto de pele com espessura parcial é uma possibilidade caso alopecia não seja uma preocupação do paciente, a área não tenha sido submetida à radioterapia e o pericrânio esteja preservado 1 .…”

Section: Discussionunclassified

Reconstrução complexa de escalpo com retalho anterolateral da coxa microcirúrgico: relato de caso

Fasolin¹,

Neto²,

Webster³

et al. 2018

Revista Brasileira De Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery

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Complications after oncologic scalp reconstruction: A 139-patient series and treatment algorithm

Cited by 32 publications

References 30 publications

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

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

Reconstrução complexa de escalpo com retalho anterolateral da coxa microcirúrgico: relato de caso

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