Reconstruction of cranioplasty using the thoracodorsal artery perforator (TDAP) flap: A case series

Scaglioni, Mario F.; Giunta, Gabriele

doi:10.1002/micr.30345

Cited by 11 publications

(13 citation statements)

References 25 publications

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“…Alloplastic implants are usually placed simultaneously with flap transfers (Chang et al, 2010; Scaglioni & Giunta, 2019). However, there are several significant disadvantages of a single‐stage approach, including an increased risk of implant loss due to flap failure, reduction of the benefits of healing when a two‐stage procedure is preformed, and decreased maximization of hair‐bearing skin.…”

Section: Discussionmentioning

confidence: 99%

The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: Report of 19 cases

Han

Chen

et al. 2021

Microsurgery

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Background Management of cranial defects following failed cranioplasty due to titanium mesh exposure and infection is challenging. The purpose of this report is to describe a modified technique using a free myocutaneous flap transfer for primary soft tissue reconstruction, and titanium mesh reinsertion for cranioplasty revision. Methods Nineteen patients with titanium mesh exposure and infection following cranioplasty were treated from January 2012 to January 2019. The average patient age was 41.89 years and the average size of the cranial defect was 7.74 × 13.92 cm. The reasons for craniotomy were craniocerebral trauma (n = 17), cerebrovascular disease (n = 1), and brain tumor (n = 1). The mean duration between implant exposure and current procedure was 7.16 months. Implant was removed and a free myocutaneous flap was designed to cover both scalp and cranium defects. After a mean duration of 12.32 months, implants were re‐inserted in a vascularized pocket at the second stage by elevating a plane between the previously transferred fascia layer and muscle layer. Results The average sizes of the muscle flaps and skin paddles were 7.74 × 13.92 cm and 4.97 × 8.97 cm. The average size of the implants was 8.24 × 14.42 cm. All flaps survived completely with no complication. After an average follow‐up of 48.16 months there were no cranioplasty failures. Functional coverage of craniectomy defect sites with normalized head contour was achieved. Conclusions The use of free myocutaneous flap and implant reinsertion achieved durable cranial and scalp defect reconstruction and aesthetic outcomes. The myocutaneous flap increases blood supply to the scalp, which may reduce the chances of infection and implant re‐exposure.

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Section: Discussionmentioning

confidence: 99%

The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: Report of 19 cases

Han

Chen

et al. 2021

Microsurgery

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“…Yet, the current literature surrounding concurrent soft tissue reconstruction with cranioplasty is limited to single institution cohort studies, case studies, and case reports. 18–23,35–37 In the present study, the majority of composite microvascular scalp reconstructions were with muscle flaps (56.3%, n = 18), followed by fasciocutaneous flaps (25%, n = 8) and pedicled myocutaneous/fasciocutaneous flaps (18.7%, n = 6). In our study, there was no statistically significant difference in overall complication between flap type (37.5% versus 15.6%, P = 0.89).…”

Section: Discussionmentioning

confidence: 51%

Trends and Outcomes of Cranioplasty Alone Versus Single-Stage Composite Scalp and Calvarial Reconstruction

Cormier

Lin

2021

Journal of Craniofacial Surgery

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Background: Cranioplasty is a critical intervention to restore the calvarium using autologous or alloplastic materials with singlestage composite scalp and calvarial reconstruction reserved for complex cases. This study aims to identify 30-day outcomes in scalp and calvarial reconstruction using the American College of Surgeons National Surgical Quality Improvement Program database. Methods: The authors conducted a retrospective analysis of the 2010 to 2018 American College of Surgeons National Surgical Quality Improvement Program database. Adult patients who underwent cranioplasty were identified using current procedural terminology coding and included by exposure type (autologous, alloplastic, composite, or other). Subjects with missing exposure or outcome data were excluded. Primary outcome was 30-day reoperation, whereas secondary outcomes were 30-day unplanned readmission and transfusion. Univariate analysis was completed to assess differences in demographics, comorbidities, and postoperative complications. Multivariable logistic regression was used to control for confounders. Results: In total, 1719 patients underwent cranioplasty (mean age 54.7 ± 15.3 years, 43.5% male), including 169(9.8%) autologous, 1303(75.8%) alloplastic, 32(1.9%) composite, and 215(12.5%) other procedures. Cranioplasty procedures were associated with 30-day complication and mortality rate of 16.5% and 2.4%, respectively. Composite cranioplasty was associated with decreased 30-day reoperation (adjusted odds ratios 0.11, 95% confidence interval 0.014-0.94, P = 0.044). There was no statistically significant difference in readmission between cranioplasty groups. Alloplastic cranioplasty was associated with decreased odds of postoperative transfusion (adjusted odds ratios 0.47, 95% confidence interval 0.27â 0.84, P= 0.01). Conclusions: Cranioplasty is an increasingly common procedure. Alloplastic cranioplasty is associated with decreased 30-day transfusion requirement, whereas single-stage composite reconstruction is a viable option and associated with decreased 30-day reoperation with no difference in readmission.

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“…To the best of our knowledge, there is a one case in the literature that reported the use of occipital artery as a recipient artery in scalp reconstruction. [ 20 ] In this study, a case with radiotherapy history, scalp defect was located in the parietooccipital area. After dissection, intimal damage in the ipsilateral occipital artery was found and anastomosis was performed to the contralateral occipital artery which was of good quality and caliber.…”

Section: Discussionmentioning

confidence: 99%

“…Superficial temporal artery is the most commonly used recipient artery, then comes the facial artery and other vessels including superior thyroid, posterior auricular, lingual, transverse cervical, external and common carotid, maxillary, and occipital artery. [ 2 , 11 - 13 , 20 ] Even though the superficial temporal artery is the most preferred recipient artery, its small caliber and the intimal damage due to the previous surgeries or irradiation occasionally limit its usage. In these cases, facial artery is chosen as a second option for recipient artery.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Reconstruction of cranioplasty using the thoracodorsal artery perforator (TDAP) flap: A case series

Abstract: Our data suggest that the TDAP may be employed in postcranioplasty reconstruction. The TDAP has more advantages compared to other flaps used in alloplastic reconstruction: a broad large surface, a long pedicle, and a thinner thickness.

Cited by 11 publications

References 25 publications

The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: Report of 19 cases

The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: Report of 19 cases

Trends and Outcomes of Cranioplasty Alone Versus Single-Stage Composite Scalp and Calvarial Reconstruction

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

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