Scalp complications of craniofacial surgery: classification, prevention, and initial approach: an updated review

Gómez, Santiago Pedroza; Gómez-Ortega, Viviana; Tovar-Spinoza, Zulma; Ghotme, Kemel A.

doi:10.1007/s00238-022-02008-2

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Partial necrosis occurred in 27.0% of patients, clinically presenting as epidermolysis of the flap, resolving without the need for surgical revision in most cases. Compared to the 0.7 to 5.5% incidence of flap necrosis on the scalp in the literature, flap necrosis occurs more commonly in irradiated patients due to impaired healing mechanisms and vascular supply [ 21 ]. Thus, using a conservative flap length or a wide-based flap in these patients is recommended.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Nikolić Živanović,

Jurišić,

Marinković

et al. 2023

Medicina

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Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients’ characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic bone necrosis (p = 0.001), as well as skin atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors’ experience in managing these patients.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Nikolić Živanović,

Jurišić,

Marinković

et al. 2023

Medicina

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“…On the other hand, complications like temporal hollowing (TH), specifically related to incisions and dissections that compromise the temporal area, for example, the pterional approach, can vary between 30 and 75%. 2 The high rate of complex microsurgical free-flap recon-structions was associated withthe relatively high propor-tion of reoperations (30.9%), which were mostly carriedout to revise vascular anastomoses. Even though free-flapreconstructions and reoperations were not associated withperioperative deaths according to the multivariate analysis,their high frequencies indirectly reflect the complexity ofthese operations.Brazilian demographic and socioeconomic characteristicsstrongly influenced the high proportion of patients withskin cancer (63.4%), many (51%) of whom underwent skull-convexity resections, meaning that this was a unique cohort.Skin cancers with cranial invasion usually reflect a longclinical course of untreated disease, and the excision of skinand soft tissue in addition to the cranial base may predisposepatients to complications.…”

Section: Introductionmentioning

confidence: 99%

Scalp Complications of Craniofacial Surgery: A Comprehensive Systematic Review

Nur Afiati,

Marini,

Sendikamas Hernawan

2024

JARMHS

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Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Google Scholar were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 21 articles, whereas the results of our search on SagePub get 87 articles, on Google Scholar 2350 articles. Records remove before screening are 1983, so we get 475 articles fos screening. After we screened based on record exclude, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: For craniofacial surgery, understanding the surgical anatomy, identifying risk factors, adequate surgical planning, and interdisciplinary cooperation between neurosurgeons, plastic surgeons, and the interdisciplinary team are essential to prevent and treat scalp complications.

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Linear Scalp Incision in Brain Tumor Surgery: Intraoperative and Postoperative Considerations

Curcio,

Lorenzetti,

Espahbodinea

et al. 2024

World Neurosurgery

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Scalp complications of craniofacial surgery: classification, prevention, and initial approach: an updated review

Cited by 3 publications

References 32 publications

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Scalp Complications of Craniofacial Surgery: A Comprehensive Systematic Review

Linear Scalp Incision in Brain Tumor Surgery: Intraoperative and Postoperative Considerations

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