Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm

Abstract

Background An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm2, whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm2. The average length of the pedicle was comparable in ALT- and LDM flaps and longer than in GM flaps. Total flap loss with need for revision surgery and minor donor site morbidity occurred in four and three patients, respectively. Conclusion Microsurgical reconstruction of moderate-to-extensive scalp defects remains a reliable method with overall low risks and satisfactory aesthetic results, while, according to our experience, muscle flaps show the best functional and aesthetic results. However, in cases of central scalp defects and in situations when a long vascular pedicle of the flap is important, the ALT flap seems to be the best solution.

An algorithmic approach to scalp reconstructive surgery: maximization of cosmetic and functional outcomes

“…The ladder proceeds in the following manner: secondary intention, primary closure, advancement flaps, rotation flaps, skin grafts, tissue expansion, and free tissue transfer [ 4 ]. The ladder begins with simpler procedures, increasing in complexity further up the ladder [ 7 , 9 ]. The best procedure is one that is simple, durable and provides the best cosmetic results.…”

Effects of CT/MRI Image Fusion on Cerebrovascular Protection, Postoperative Complications, and Limb Functional Recovery in Patients with Anterior and Middle Skull Base Tumors: Based on a Retrospective Cohort Study

“…In order to comprehensively apply a variety of imaging modes to obtain more comprehensive image information, it is often necessary to integrate, compare, and analyze the effective information in clinical work. At first, image registration and lesion localization only by human brain analysis depend on the empirical judgment of the observer, so it is difficult to avoid errors in the understanding of tumor extent between observations and observers themselves [11]. In the 1990s, medical image fusion technology gradually appeared in people's line of sight.…”

Fallbericht einer Frontobasisrekonstruktion und Volumenkorrektur durch freie M. gracilis-Lappenplastik und autologe Fett-Transplantation – Die Lappenplastik als Scaffold für eine Fettgewebe-Transplantation

“…Zur Vermeidung dieser sekundären Eingriffe hat die präoperative Evaluation der rekonstruktiven Möglichkeiten einen besonderen Stellenwert. Zahlreiche Algorithmen zum Vorgehen bei Rekonstruktionen des Kraniums, unter Berücksichtigung der ästhetischen Einheit und mit dem Ziel der Maximierung der haartragenden Kopfhaut, wurden bereits publiziert und geben Empfehlungen zur Defektdeckung, beruhend auf Lokalisation und/oder Größe der Läsion [10,[15][16][17][18]. Ooi et al postulieren dabei eine Defektgröße von 100 cm 2 als kritisch, die einer Defektdeckung mittels freier Lappenplastik bedarf [16].…”