Scalp Reconstruction With Free Latissimus Dorsi Flap in a Patient With Giant Cutis Verticis Gyrata

Abstract

Cerebriform intradermal nevus is one of the most common causes of cutis verticis gyrata and has an importance due to the current risk of malign transformation. Latissimus dorsi musculocutaneous free flap is a reliable and aesthetically acceptable reconstruction option in the patients of giant cutis verticis gyrata due to sufficient pedicle length, reliable vascularized tissue volume, and large surface area.

Cutis Verticis Gyrata Secondary to Cerebriform Intradermal Naevus: A rare entity and its Management

“…However, secondary CVG can be caused by various disorders from local inflammatory disease of the scalp such as eczema, psoriasis, impetigo, erysipelas and pemphigus, to local neoplastic changes including melanocytic nevi, dermatofibromas, hamartomas and cylindroma. Systemic disease such as syphilis, tuberous sclerosis, leukaemia, neurofibromatosis, amyloidosis, acromegaly, Ehler-Danlos syndrome, pachydermoperiostosis are also being reported as the secondary association of CVG [1,6,7]. As depicted in this case, 25% of secondary CVG is caused by tumour, with dermal nevus being the most common reason.…”

“…The findings for the histopathology are concurrent with the excised lesion seen in our patient (Figure 2). While CIN is usually benign, there are reported risk of malignant melanoma of up to 10% developed from cerebriform intradermal nevus [7]. The mainstay of the treatment for CIN with CVG is surgical excision and reconstruction in accordance with the reconstructive ladder.…”

Scalp expansion for giant cutis verticis gyrata secondary to cerebriform intradermal nevus

“…All cases of surgically managed CVG published in the literature according to our PubMed search are listed in Table 1. 2,4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Thirty-five patients (11 female, 24 male; mean age, 26.9 years) with CVG (maximum lesion diameter, 8-32 cm) were successfully treated with scalp excision followed by direct suturing (n ¼ 9), scalp subcision (n ¼ 1), local flaps (n ¼ 2), free flaps (n ¼ 2), skin grafts (n ¼ 3), and scalp expansion (n ¼ 18). Various excision patterns have been reported, such as a Y-shaped excision, Tshaped excision, fleur-de-lis pattern, and butterfly-shaped excision.…”

Modified Cranioplasty and Latissimus Dorsi Flap for an Exophytic Invasive Brain Tumor

“…10 The principal indication for the use of LDF for scalp reconstruction is in defects greater than 200 cm 2 caused by radical tumor resections or radiation therapy. 11,12 Characteristics that favor its use include its large size, easy harvesting, blood supply, and excellent vascularity to the recipient tissue. 13 Only the muscular component is generally used and later covered with a split-thickness skin graft from one anterolateral tight, with the objective that after atrophy of the muscle, the thickness will approximate that of the rest of the scalp with excellent cosmetic results.…”

“…Latissimus dorsi flap (LDF) was first introduced by Maxwell and colleagues in 1978, 9 and since then, it has been considered the preferred free flap 10 . The principal indication for the use of LDF for scalp reconstruction is in defects greater than 200 cm 2 caused by radical tumor resections or radiation therapy 11,12 . Characteristics that favor its use include its large size, easy harvesting, blood supply, and excellent vascularity to the recipient tissue 13 .…”