Reconstruction of Complex Scalp Defects in Different Locations: Suggestions for Puzzle

Abstract

Objective: Scalp defects may occur following trauma, radiotherapy, oncologic resection, and recurrent surgeries. The hair-bearing scalp has a dual role, which consists of protecting the calvarium and contributing to aesthetic appearance. While the “reconstructive ladder” approach may be used to close small and medium-sized scalp defects, it is not the case for larger ones involving the calvarium or with a radiation therapy history. The aim of this study is to present cases operated due to complex scalp defects, analyze complications, and discuss the choice of reconstruction. Material and Methods: The study consists of 14 patients who were operated between December 2017 and August 2019 due to a complex scalp defect. Patient were evaluated according to age, gender, etiology, radiation therapy history, defect size and location, reconstruction steps, cranioplasty and duraplasty options, type of free flap, recipient artery, vein graft requirement, and complications. Results: The mean age of patients, which consists of 11 men and three women, was 56.7 years. The etiology for scalp defects included basosquamous carcinoma, squamous cell carcinoma, giant basal cell carcinoma, atypical meningioma, glioblastoma multiforme, angiosarcoma, and anaplastic oligodendroglioma. The defect involved the full thickness of calvarium in nine cases and pericranium in five cases. Cranioplasties were made with rib graft ( n =1), bone graft ( n =1), and titanium mesh ( n =7). Free flaps used for reconstruction were musculocutaneous latissimus dorsi (LD) ( n =4), LD muscle ( n =3), anterolateral thigh (ALT) ( n =4), musculocutaneous ALT ( n =1), vastus lateralis muscle (1), and rectus abdominis muscle ( n =1). Flap loss was not observed. Complications occurred in four of the patients; include a partial graft loss, a wound dehiscence, seroma, and an unsatisfactory esthetic result. Conclusion: Free tissue transfers rather than local flaps should be opted to reconstruct complex scalp defects, as failure of the latter, could create much greater defects, and worse consequences. There are many options for proper reconstruction, and it is essential to select the appropriate one, taking into account the comorbid conditions of each case.

Tradition Or Innovation In Sternal Dehiscence Repair: Robicsek versus Titanium Plate

“…Titanium plates are used in many surgical fields today. [ 13 ] As in our patient series, possible new complications and new interventions can be prevented with titanium plate method in patients with sternal detachment. However which method to use for sternum detachment should be individually evaluated for each patient.…”

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

“…It can also be used for the reconstruction of scalp defects and, in rare cases, in cases where coverage with other flaps, such as ALT flap, is difficult for traumatic injury in the lower extremities. [20][21][22][23][24][25] Of these, the LD flap has been used most often in breast reconstruction. 26 With consistent advances in the field of breast reconstruction in the recent years, the types of reconstruction methods have also become more diverse.…”

“…It can also be used for the reconstruction of scalp defects and, in rare cases, in cases where coverage with other flaps, such as ALT flap, is difficult for traumatic injury in the lower extremities. 20 21 22 23 24 25 Of these, the LD flap has been used most often in breast reconstruction. 26…”

“…Owing to such advantages, it is a flap used in not only breast reconstruction, but also in the reconstruction of large and complex tissue defects in the maxillofacial region. It can also be used for the reconstruction of scalp defects, and in rare cases, in reconstruction cases where coverage with other flaps, such as ALT flap, is difficult for traumatic injury in the lower extremities 16,17,18,21,22,23 . Of these, the LD flap has been used most often in breast reconstruction 11 .…”

The 1-2-3 cm Advancement Flap Rule in Scalp Reconstruction

“…The reconstruction of scalp defects can be challenging for several reasons: limited tissue displacement and variable degrees of resistance at different points on the scalp, as well as individual factors such as age, sex, and comorbidities [ 2 ]. In order for a surgeon to perform an optimal reconstruction, the reconstructive plan should take into account the patient’s own preferences and intrinsic and extrinsic factors including age, smoking, the use of corticosteroids, previous surgical incisions, cerebrospinal fluid (CSF) leakage, defect size and location, local tissue quality, hair distortion, radiation, the presence or absence of periosteum, the location of the hairline, and the presence of other comorbidities [ 3 - 5 ].…”