Microsurgical Reconstruction of Extensive Scalp Defects

Abstract

Large, full-thickness scalp defects represent a reconstructive challenge that has benefitted greatly from the introduction of microsurgical techniques. The authors review their experience with 16 patients with acquired defects of the scalp for which local or regional reconstructive options were unavailable. The mean age at the time of operation was 44.8 years. Nine patients underwent resection of malignant scalp lesions, followed immediately by free-flap coverage. Six patients required revision procedures for unstable scar as a result of prior trauma (2), old scalp avulsions (2), and multiple intracranial procedures (2). The remaining patient underwent replantation of an acutely avulsed scalp. The free-flap donor sites utilized included latissimus (6), scapular (3), radial forearm (2), rectus abdomnis (2), and omentum (2). Vein grafts were required in four cases. All flaps survived, although one required anastomotic revision and skin grafting for superficial loss. Additional complications were limited to seromas at two latissimus donor sites. Tumor control rates were poor, with all malignancy-associated defects having persistent disease or recurring soon after surgery. All patients eventually achieved full defect coverage. The authors conclude that microsurgical reconstruction is a reliable option for providing stable coverage of large, complex, scalp defects.

Microvascular Free Tissue Transfer in the Reconstruction of Scalp and Lateral Temporal Bone Defects

“…2), anterolateral thigh (6; see Fig. 3), radial forearm (4), and omental (1) . For microvascular anastomosis, the donor arteries utilized were superior thyroid (32), transverse cervical (14), facial (18), lingual (2), and occipital (1).…”

“…3), radial forearm (4), and omental (1) . For microvascular anastomosis, the donor arteries utilized were superior thyroid (32), transverse cervical (14), facial (18), lingual (2), and occipital (1). Donor veins were comprised of external jugular (39), superior thyroid (4), internal jugular (9), facial (10), retromandibular (2), and transverse cervical (3).…”

Aesthetic and functional advantages of the anterolateral thigh flap in reconstruction of tumor‐related scalp defects

“…The mean extent of defects was 169.5 qcm, ranging from 30À600 qcm. Twelve free flaps utilized for reconstruction included anterolateral thigh flaps (8), a suprafascial radial forearm flap (1), a lateral arm flap (1), a latissimus dorsi muscle flap with splitthickness skin graft (1), and a myocutaneous vertical rectus abdominis flap (1). The latter flap was done before the author started using the anterolateral thigh flap.…”

“…The average extension of defects was 169.5 (range, 30À600) qcm. Free flaps employed for reconstruction included antero-lateral thigh flaps (8), suprafascial radial forearm flap (1), lateral arm flap (1), latissimus dorsi muscle flap (1), and myocutaneous vertical rectus abdominis flap (1). Other procedures included nerve grafts to the facial nerve (2), ectropion correction (2), and fascia lata slings for static procedure in facial palsy (2).…”

Anterolateral Thigh Flap Reconstruction of Large External Facial Skin Defects: A Follow-Up Study on Functional and Aesthetic Recipient- and Donor-Site Outcome

“…In larger defects with exposed bone or dura, the advantages of free flaps for head and neck reconstruction have been demonstrated in several studies. [1][2][3][4][5] An ideal soft-tissue free flap for head and neck reconstruction should have the following characteristics 6,7 : versatility in design, adequate tissue stock, superior texture, minimal donor-site morbidity, availability of diverse tissue types on one pedicle, potential for reinnervation, large and long pedicle, feasibility of a two-team approach, and consistent anatomy for an easy and safe flap dissection. Except for the latter, the anterolateral thigh flap 8 has been suggested to have all of these qualities, 9 which prompted us to start using this flap for reconstructing large skin defects of the face and forehead after malignant tumor resection.…”