Free Flap Reconstruction of the Scalp and Calvaria of Major Neurosurgical Resections in Cancer Patients: Lessons Learned Closing Large, Difficult Wounds of the Dura and Skull

Wang, Howard T.; Erdmann, Detlev; Olbrich, Kevin C.; Friedman, Allan H.; Levin, L. Scott; Zenn, Michael R.

doi:10.1097/01.prs.0000240830.19716.c2

Cited by 72 publications

(63 citation statements)

References 14 publications

(10 reference statements)

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“…The average size of the defect (135 cm 2 ) was also similar to previous publications [2,5,12]. The defects with the largest surface areas were located in the occipital region with the only statistical difference being between occipital and frontal regions ( P = 0.028).…”

Section: Discussionsupporting

confidence: 88%

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Reconstruction of scalp defects with the radial forearm free flap

et al. 2012

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BackgroundAdvanced and recurrent cutaneous squamous cell carcinoma of the scalp and forehead require aggressive surgical excision often resulting in complex defects requiring reconstruction. This study evaluates various microvascular free flap reconstructions in this patient population, including the rarely utilized radial forearm free flap.Patients and methodsA retrospective review of patients undergoing free flap surgeries (n = 47) of the scalp between 1997 and 2011 were included. Patients were divided primarily into two cohorts: a new primary lesion (n = 21) or recurrence (n = 26). Factors examined include patient demographics, indication for surgery, defect, type of flap used, complications (major and minor), and outcomes.ResultsThe patients were primarily male (n = 34), with a mean age of 67 years (25–91). A total of 58 microvascular free flap reconstructions were performed (radial forearm free flap: n = 28, latissimus dorsi: n = 20, rectus abdominis: n = 9, scapula: n = 1). Following reconstruction with a radial forearm free flap, duration of hospitalization was shorter (P = 0.04) and complications rates were similar (P = 0.46). Donor site selection correlated with defect area (P < 0.001), but not with the extent of skull defect (P = 0.70). Larger defect areas correlated with higher complications rates (P = 0.03) and longer hospitalization (P = 0.003). Patients were more likely to require multiple reconstructions if referred for a recurrent lesions (P = 0.01) or received prior radiation therapy (P = 0.02).ConclusionAdvanced and recurrent malignancies of the scalp are aggressive and challenging to treat. The radial forearm free flap is an underutilized free flap in the reconstruction of complex scalp defects.

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Section: Discussionsupporting

confidence: 88%

“…A number of articles have discussed microvascular free flap reconstruction of complex scalp defects following calvarial and dural resections [5-8]. However, previous publications report limited utilization of the radial forearm free flap (< 10%), if any, for reconstructions of the scalp.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of scalp defects with the radial forearm free flap

et al. 2012

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“…Furthermore, a defect that has some possibility of residual tumor in the wound bed is not a good candidate for local flap coverage. In case of nearly total defect in the scalp, distant flaps as various as anterolateral thigh flap, latissimus dorsi muscle flap, radial forearm free flap, transverse rectus abdominus myocutaneous flap can be used [4-6]. …”

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confidence: 99%

One Stage Reconstruction of Skull Exposed by Burn Injury Using a Tissue Expansion Technique

et al. 2012

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BackgroundAn area of the skull exposed by burn injury has been covered by various methods including local flap, skin graft, or free flap surgery. Each method has disadvantages, such as postoperative alopecia or donor site morbidities. Due to the risk of osteomyelitis in the injured skull during the expansion period, tissue expansion was excluded from primary reconstruction. However, successful primary reconstruction was possible in burned skull by tissue expansion.MethodsFrom January 2000 to 2011, tissue expansion surgery was performed on 10 patients who had sustained electrical burn injuries. In the 3 initial cases, removal of the injured part of the skull and a bone graft was performed. In the latter 7 cases, the injured skull tissue was preserved and covered with a scalp flap directly to obtain natural bone healing and bone remodeling.ResultsThe mean age of patients was 49.9±12.2 years, with 8 male and 2 female. The size of the burn wound was an average of 119.6±36.7 cm2. The mean expansion duration was 65.5±5.6 days, and the inflation volume was an average of 615±197.6 mL. Mean defect size was 122.2±34.9 cm2. The complications including infection, hematoma, and the exposure of the expander were observed in 4 cases. Nonetheless, only 1 case required revision.ConclusionsSuccessful coverage was performed by tissue expansion surgery in burned skull primarily and no secondary reconstruction was needed. Although the risks of osteomyelitis during the expansion period were present, constant coverage of the injured skull and active wound treatment helped successful primary reconstruction of burned skull by tissue expansion.

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“…Free tissue transfer has been promoted as a both a safe and salvage technique for cranioplasty, while failure of dura re-expansion has been postulated as a reason for cranioplasty failure. 3,5,32 The second revision was due to an overlying soft tissue laceration leading to infection; the third due to improper plate placement and fixation.…”

Section: Discussionmentioning

confidence: 99%