Microsurgical Scalp Reconstruction in the Elderly

Self Cite

Background: A major challenge in face transplantation (FT) is the limited donor allograft pool. This study aimed to investigate the feasibility of cross-sex FT (CSFT) for donor pool expansion by: (1) comparing craniomaxillofacial metrics following CSFT versus same-sex FT (SSFT); and (2) evaluating the public and medical professionals’ perception of CSFT. Methods: Seven cadaveric FTs were performed, resulting in both CSFT and SSFT. Precision of bony and soft tissue inset was evaluated by comparing pre- versus post-operative cephalometric and anthropometric measurements. Fidelity of the FT compared to the virtual plan was assessed by imaging overlay techniques. Surveys were administered to medical professionals, medical students, and general population to evaluate opinions regarding CSFT. Results: Five CSFTs and 2 SSFTs were performed. Comparison of recipients versus post-transplant outcomes showed that only the bigonial and medial intercanthal distances were statistically different between CSFT and SSFT (P = 0.012 and P = 0.010, respectively). Of the 213 survey participants, more were willing to donate for and undergo SSFT, compared with CSFT (donate: 59.6% versus 53.0%, P = 0.001; receive: 79.5% versus 52.3%, P < 0.001). If supported by research, willingness to receive a CSFT significantly increased to 65.6% (P < 0.001). On non-blinded and blinded assessments, 62.9% and 79% of responses rated the CSFT superior or equal to SSFT, respectively. Conclusions: Our study demonstrates similar anthropometric and cephalometric outcomes for CSFT and SSFT. Participants were more reticent to undergo CSFT, with increased willingness if supported by research. CSFT may represent a viable option for expansion of the donor pool in future patients prepared to undergo transplantation.

Section: Discussionmentioning

confidence: 99%

Feasibility and Perception of Cross-sex Face Transplantation to Expand the Donor Pool

Sosin

Robinson

Diep

et al. 2020

Self Cite

“… 3 Microvascular surgery may be safely and successfully performed in the elderly, with major complications ranging from 7% to 10% and flap survival rates of 96%. 3 , 8 These authors did agree that the use of free flaps has to be individualized and patient centered. 3 , 8 Although free flap and pedicled flap reconstructions provide good vascularized tissue, they do involve a more prolonged general anesthesia, additional donor sites, and more extensive recovery, which patients may not be willing to endure.…”

Section: Discussionmentioning

confidence: 99%

“… 3 , 8 These authors did agree that the use of free flaps has to be individualized and patient centered. 3 , 8 Although free flap and pedicled flap reconstructions provide good vascularized tissue, they do involve a more prolonged general anesthesia, additional donor sites, and more extensive recovery, which patients may not be willing to endure. Yet, certain defect-related factors benefit from microvascular reconstruction with either myocutaneous or fasciocutaneous flap.…”

Section: Discussionmentioning

confidence: 99%

Use of Pericranial Flaps with Dermal Substitute for Scalp Reconstruction: A Case Series

Chaiyasate

Oliver

Kreitzberg

et al. 2020

Background: Skin cancer incidence has been rapidly increasing over the past 2 decades, and the resulting defects from excision have significant aesthetic and functional implications. In particular, wound coverage for large scalp and forehead defects with calvarial exposure can lead to hairline distortion, contour irregularities, and alopecia. We describe a 2-stage technique for scalp reconstruction, which preserves the normal hairline, covers exposed bone with vascularized tissue, and restores an aesthetic soft-tissue contour. Methods: This is a retrospective case series of 13 adults with ages ranging from 50 to 89 years. All patients underwent Mohs surgery on the forehead or scalp between July 2014 and April 2017. Patients underwent a 2-staged reconstruction with an initial pericranial flap and dermal substitute placement followed by the placement of a split-thickness skin graft within 4–6 weeks. Results: Over a 3-year period, 13 patients had successful reconstruction of the scalp defect without alteration of the hairline or contour irregularity. Two patients had minor complications after the first-stage procedure with successful aesthetic reconstruction. Conclusions: Full-thickness defects of the scalp and forehead with bone exposure provide a reconstructive challenge for plastic surgeons. Reconstructive algorithms continue to evolve and should be tailored to best suit patients’ needs and medial comorbidities. Two-staged reconstruction with local pericranial flap provides a safe and efficacious reconstruction that minimizes hairline distortion, contour irregularity, and donor site morbidity.

“…21–23 However, advances in anesthesia methods along with surgical techniques have allowed even complicated reconstructive methods to proceed with success. 24–26 …”

Section: Discussionmentioning

confidence: 99%

Safety of Immediate Posterior Trunk Soft-Tissue Reconstruction in Older Adults

Calotta

Coon

Sacks

2017

Background:Older patients, especially those older than 65 years, are accounting for an ever-increasing share of hospital costs, especially surgical procedures. Studies regarding the safety of surgery in these patients have been widespread in the past decade. Despite these efforts, there is a paucity of information regarding the safety of reconstruction following spinal surgery in older patients.Methods:We conducted a retrospective cohort study of patients undergoing soft-tissue reconstruction of the posterior trunk after oncologic spine surgery. Demographic, medical, and surgical variables were measured. The primary outcome variable was the development of a medical or surgical complication postoperatively. Other secondary outcomes included development of a medical complication alone, specific surgical complications (seroma, hematoma, infection, wound dehiscence, and (cerebrospinal fluid leak), unplanned reoperation, and 60-day operative mortality.Results:A priori power analysis suggested 205 cases would be needed. The study included 286 cases in 256 patients. The cohorts were similar in terms of demographic, surgical, and medical variables, though the older cohort had higher mean American Society of Anesthesiologists score (2.09 versus 1.65; P < 0.0001). We found no correlation between increasing age and increased rates of medical or surgical complications (35.9% for older patients versus 44.7% for younger patients; P = 0.31). However, mean American Society of Anesthesiologists score did correlate with complications (1.88 for patients with complications versus 1.69 for patients without; P = 0.04).Conclusions:We demonstrated no increased risk for complications among older patients. Complex soft-tissue reconstruction of the posterior trunk is safe in elderly patients undergoing oncologic spinal surgery.