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

Abstract

Defects of the scalp and lateral temporal bone (LTB) represent a unique challenge to the reconstructive surgeon. Simple reconstructive methods such as skin grafts, locoregional flaps, or tissue expanders are often not feasible due to a myriad of reasons. Vascularized free tissue transfer coverage offers distinct advantages in managing these defects. A retrospective case series was performed on all patients at the University of Washington Medical Center who had scalp or LTB defects reconstructed with free tissue transfer from May 1996 to July 2009. Cases were analyzed for defect characteristics, flap type, vessel selection, radiation status, dural exposure, complications, and outcomes. Sixtyeight free flaps were performed in 65 patients with scalp or LTB defects. Twenty-two resections included craniotomy, and 48 patients had pre-or postoperative radiation. Defects ranged from 6 to 836 cm 2 . All flaps (46 latissimus, 11 rectus, 4 radial forearm, 6 anterolateral thigh, and 1 omental) were transferred successfully. Vein grafts were required in five cases. Complications included delayed flap failure requiring secondary reconstruction, neck hematoma, venous thrombosis, skull base infection, large wound dehiscence, small wound dehiscence, donor site hematoma and seroma, and cerebrospinal fluid leak. Cosmetic results were consistent and durable. Microvascular free tissue transfer is a safe, reliable method of reconstructing scalp and LTB defects and offers favorable cosmetic results. We favor the use of latissimus muscle-only flap with skin graft coverage for large scalp defects and rectus or anterolateral thigh free flaps for lateral temporal bone defects.

Autologous Immediate Cranioplasty with Vascularized Bone in High-Risk Composite Cranial Defects

“…[10][11][12] Thus, in cases of high-risk composite defects, free tissue transfer may indeed be the best solution because of scarring and poor vascularity of the surrounding tissue. 11,13 In this regard, 42.9 percent of the patients in our study underwent previously failed reconstructive attempts.…”

Incidence of cerebrospinal fluid leak following petrosectomy and analysis of avoidance techniques

“…These include latissiumus dorsi, rectus abdominis, radial forearm, anterolateral thigh, omentum, pericranium and external oblique fascia. 3,[14][15][16][17] These are integrated either as a free tissue transfer or a pedicalized, vascularized flap. Occasionally, vein grafts may be required to lengthen the vascular pedicle in reconstructions.…”

The Role of Free Tissue Transfer in Merkel Cell Carcinoma of the Head and Neck

“…For defects in the dura, tensor fascia lata grafting is commonly employed with good results. Donor vessels commonly used are superficial temporal system, facial artery, superior thyroid artery, and transverse cervical system [21, 22]. Donor site selection involves a relatively complicated assessment of the ablative defect, the composition of the defect, and the overall condition of the patient.…”