Free-Flap Reconstruction of Large Defects of the Scalp and Calvarium

Dg, Pennington; Hs, Stern; Lee, KK

doi:10.1097/00006534-198904000-00010

Cited by 107 publications

(53 citation statements)

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“…Both of these methods can provide adequate functional coverage, albeit with a poor cosmetic result. 1 Over the last decade, several viable skin substitutes have become available for clinical use. Integra is a tissueengineered bilayer matrix with a dermal layer composed of a porous matrix of fibers of cross-linked bovine tendon collagen and a glycosaminoglycan (chondroitin-6-sulfate) and a …”

Section: Discussionmentioning

confidence: 99%

“…Although a variety of techniques exists for providing stable coverage to the cranium which has become exposed secondary to trauma, infection, or surgical ablation, these techniques often require multiple operations and a significant time commitment on the part of the patient and the surgeon. [1][2][3][4][5][6] Unfortunately, when local (scalp) tissue is insufficient or unavailable, there are no reliable reconstructive methods that can recreate the look of natural-appearing hair on the reconstructed scalp.…”

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confidence: 99%

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Hair-Bearing Scalp Reconstruction Using a Dermal Regeneration Template and Micrograft Hair Transplantation

Spector

Glat²

2007

Annals of Plastic Surgery

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The scalp has traditionally presented a challenge to the reconstructive surgeon. Although a variety of techniques exists for providing stable coverage to the cranium that has become exposed secondary to trauma, infection, or surgical ablation, these techniques tend to require multiple operations and a significant time commitment on the part of the patient and the surgeon. Unfortunately, most if not all of these techniques are unable to recreate the appearance of natural-appearing hair on the reconstructed scalp. We present our unique experience utilizing a tissue-engineered dermal regeneration template for reconstruction of the traumatized scalp. Once vascularized and skin grafted, the neodermis received approximately 1600 microfollicular hair grafts, which resulted in a pleasing esthetic outcome. In this case, a 50-year-old man suffered a significant degloving of the posterior portion of the scalp. The area of exposed periosteum/galea was covered acutely with Integra dermal regeneration template, followed by skin grafting 2 weeks later. Since the patient refused tissue expansion reconstruction, a trial of hair micrografting (100 grafts) into the Integra was performed, with good results. Two subsequent sessions of 800 grafts placed also had good results. This report represents the first use of sequential hair micrografting into Integra dermal regeneration template to reconstruct hair-bearing scalp. Application of a dermal regeneration template with a thin split-thickness skin graft followed by sequential hair micrografting is a viable alternative for hair-bearing scalp reconstruction in cases where traditional methods (eg, tissue expansion, microvascular free tissue transfer) are unavailable or undesirable.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Hair-Bearing Scalp Reconstruction Using a Dermal Regeneration Template and Micrograft Hair Transplantation

Spector

Glat²

2007

Annals of Plastic Surgery

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“…4 Otherwise, the latissimus dorsi muscle appears to be the prime candidate due to its large surface area, consistent pedicle anatomy, and superb vascularity. 2,[5][6][7][8] However, others have promoted composite flaps where the cutaneous component negates the need for a skin graft, which is more esthetically pleasing; and, of course, no functioning muscle need be sacrificed. 3,9,10 Most of these series have only short-term patient follow-ups, so if a functional difference ultimately develops remains unknown.…”

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confidence: 99%

Long-Term Superiority of Composite Versus Muscle-Only Free Flaps for Skull Coverage

Hallock¹

2004

Annals of Plastic Surgery

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Long-term follow-up of free flaps used for skull coverage in this experience has revealed that serious sequela are more likely after muscle-only free flaps. Over the past 2 decades, 8 muscle and 6 composite free flaps have been used in 12 patients. Debulking was the only secondary procedure necessary in 1 composite flap. However, implant extrusion through 1 muscle flap and chronic ulcerations after minor trauma in 2 other muscle flaps could be directly attributed to the thinness of these flaps. Whether these problems were a consequence of inevitable muscle atrophy or improper selection of too thin a muscle flap from the outset is unknown. Thus, it must be suggested that either a composite flap or a known thick muscle should be chosen initially if a permanent trouble-free outcome is to be expected.

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“…These include the latissimus dorsi (LD) (3,4), combined LD and serratus (5), omentum (6), scapula (7), rectus abdominis (8), radial forearm (9), iliac crest-internal oblique osteomyocutaneous flap (10) and a multiterritory (scapular, parascapular, LD and lateral thoracic) flap (11). In our experience, the LD free transfer is the flap of choice for many of these defects.…”

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confidence: 99%

Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects

Zhong¹,

Pj²

2003

J Plast Surg

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BACKGROUND: The reconstruction of large scalp defects is occasionally required. Several methods of scalp reconstruction have previously been described. This paper presents the authors' experience with two patients in whom traditional methods were not sufficient and in whom bilateral latissimus dorsi free flaps were required. OBJECTIVES: To evaluate the effectiveness of a new technique in reconstructing extensive scalp defects. METHODS: Two case histories are presented. These include the rationale for the choice of reconstruction used as well as a discussion on the technical features of the surgery. RESULTS: Reconstruction was effective in both cases. However, one patient died in the early postoperative period from a pulmonary embolus. CONCLUSIONS: Bilateral latissimus flaps can be safely and effectively used in closing massive scalp defects in selected cases.

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Free-Flap Reconstruction of Large Defects of the Scalp and Calvarium

Cited by 107 publications

References 0 publications

Hair-Bearing Scalp Reconstruction Using a Dermal Regeneration Template and Micrograft Hair Transplantation

Hair-Bearing Scalp Reconstruction Using a Dermal Regeneration Template and Micrograft Hair Transplantation

Long-Term Superiority of Composite Versus Muscle-Only Free Flaps for Skull Coverage

Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects

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