Microvascular approach to scalp replantation and reconstruction: A thirty‐six year experience

Herrera, Fernando; Buntic, Rudolf F.; Brooks, Darrell; Buncke, Gregory M.; Antony, M.P.H. Anuja K.

doi:10.1002/micr.22037

Cited by 46 publications

(56 citation statements)

References 32 publications

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“…9 As reported in the literature, [15][16][17] our patient reported adequate sensitivity over 1 year despite nerve avulsion and the absence of any nerve anastomosis. A temporary hair loss was observed, which is not uncommon.…”

Section: Discussionsupporting

confidence: 77%

Microsurgical Replantation of a Two-Segment Total Scalp Avulsion

Henry

Lucas

et al. 2016

Journal of Craniofacial Surgery

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Total scalp avulsion is a rare and severe injury that may be life threatening and can result in devastating disfigurement and psychological trauma. Microsurgical hair-bearing scalp replantation is considered the procedure of choice and should be performed by a skilled surgical team. Replantation of a multifragmented scalp is even rarer and shows random results. Only 2 patients have been reported, resulting in partial or total necrosis of implanted fragments. The authors describe the successful replantation of a totally avulsed 2-segment scalp in a 63-year-old woman whose hair was entrapped in the propeller shaft of a ship. The avulsed scalp involved both eyebrows, the frontal region, the upper part of both ears, and most of the occipital portion. After initial management including correction of hemorrhagic shock, the patient underwent emergency scalp replantation by microsurgical anastomosis of 3 arteries and 4 veins and the use of 2 vein grafts.According to authors' experience, multifragmented scalp avulsion imposes emergency relocation using as many microsurgical sutures as possible and implementation of vein grafts to ensure optimal revascularization of the avulsed scalp.

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Section: Discussionsupporting

confidence: 77%

Microsurgical Replantation of a Two-Segment Total Scalp Avulsion

Henry

Lucas

et al. 2016

Journal of Craniofacial Surgery

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“…[5] The latissimus dorsi muscle can serve as a musculocutaneous or muscular flap in scalp reconstruction, given its large surface area and long vascular pedicle. [6,7] However, it has certain disadvantages that include the requirement of repositioning the patient intraoperatively to harvest the flap, an unnatural appearance of a skin island in the scalp, difficulty in clinical flap monitoring particularly for the muscle-only flaps, a lack of durability in split-thickness grafts, potential complications such as seroma and wound dehiscence in the donor area, and, finally, sacrification of a functional muscle. [8] The serratus anterior flap is another option for scalp reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Extensive Scalp Defects With Anterolateral Thigh Flap

Altinkaya

Yazar²,

Sağlam³

et al. 2018

Ulus Travma Acil Cerrahi Derg

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“…The serratus anterior free flap (SAFF) was first described in 1982 by Takayanagi and Tsukie for reconstruction of lower limb defects . In the following, the SAFF has found many applications in head and neck reconstruction, including reconstruction of the oral cavity, the scalp, the skull base, craniofacial defects or the oesophagus …”

Section: Introductionmentioning

confidence: 99%

Design of skin islands for a myocutaneous serratus anterior free flap—An anatomical study and clinical implication for pharyngeal reconstruction after laryngopharyngectomy

Janik

Paraszti

Hirtler

et al. 2018

Clinical Otolaryngology

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Objectives The main purpose of this study was to evaluate flap size and flap design of skin islands in myocutaneous serratus anterior free flaps (SAFFs) in fresh cadavers and to further investigate whether myocutaneous SAFFs are suitable flaps for pharyngeal reconstruction after laryngopharyngectomy. Methods Dissection and injection of methylene blue were performed in 20 hemithoraces of 13 fresh cadavers to evaluate flap size and location of skin islands. Based on these pre‐clinical data, we performed pharyngeal reconstruction with myocutaneous SAFF in five patients after laryngopharyngectomy. Results Perfused skin paddles were found in all specimens with a mean size of perfused skin islands of 85.6 ± 49.8 cm2. Lengths and widths of skin islands ranged from 10‐21 cm and 6‐20.5 cm respectively. Flap size did not significantly differ between males and females (P = 0.998), left compared to right hemithoraces (P = 0.468) and between paired specimens (P = 0.915). All skin islands were found within the upper 29.3%‐51.7% of hemithorax (calculated from axilla to costal arch), and between latissimus dorsi muscle posteriorly and anterior axillary line anteriorly. Accordingly, myocutaneous SAFFs were used for pharyngeal reconstruction after laryngopharyngectomy in five patients with advanced hypopharyngeal carcinomas. Three patients had uneventful courses, while one patient developed immediate intraoperative flap loss and another patient developed partial necrosis of SAFF on postoperative day 7. Conclusion Skin islands of SAFF have reliable blood supply, which allow harvest of large myocutaneous SAFFs that can be used also for pharyngeal reconstruction after laryngopharyngectomy.

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Microvascular approach to scalp replantation and reconstruction: A thirty‐six year experience

Cited by 46 publications

References 32 publications

Microsurgical Replantation of a Two-Segment Total Scalp Avulsion

Microsurgical Replantation of a Two-Segment Total Scalp Avulsion

Reconstruction of Extensive Scalp Defects With Anterolateral Thigh Flap

Design of skin islands for a myocutaneous serratus anterior free flap—An anatomical study and clinical implication for pharyngeal reconstruction after laryngopharyngectomy

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