Scalp, Skull, and Dura Reconstruction on an Emergency Basis

Wei, Fu‐Chan; Tsao, Su‐Ben; Chang, Chen-Nen; Noordhoff, M. Samuel

doi:10.1097/00000637-198703000-00014

Cited by 12 publications

(9 citation statements)

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“…Successful emergency microsurgery for patients with a major, complex wounds in the head and neck region has been reported [1][2][3][4][5][6]. In particular, microsurgery is found to be effective for repairing avulsion wounds.…”

Section: Discussionmentioning

confidence: 99%

“…We have reconstructed scalp, bone, and dura composite defects caused by tumor resection, exposure of artificial skull, and major trauma. Successful microsurgery for patients with large scalp defect has been performed using latissimus dorsi myocutaneous flap [1,2], rectus abdominis myocutaneous flap [3], vastus lateralis muscle flap [4], and anterolateral thigh flap [5,6]. However, there are no guidelines for when and how reconstruction should be performed after major trauma.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency microsurgery for patients with soft tissue, skull, and dura complex defects after trauma: a case report

Okochi

Komuro

2019

Case Reports in Plastic Surgery and Hand Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency microsurgery for patients with soft tissue, skull, and dura complex defects after trauma: a case report

Okochi

Komuro

2019

Case Reports in Plastic Surgery and Hand Surgery

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“…In an otherwise healthy wound bed where radiotherapy is not anticipated, there are a variety of viable options, including skull reconstruction with rib grafts or titanium, and coverage with a free flap. [34] If adjuvant radiotherapy is planned, titanium mesh covered with a fasciocutaneous free flap is an appropriate option. If the wound bed has been previously infected or irradiated, non-vascularised grafts and alloplastic materials may not be sufficient.…”

Section: Discussionmentioning

confidence: 99%

The management of non-melanocytic skin malignancies of the scalp and calvarium

Çöloğlu

Özkan

Şener

et al. 2014

Indian J Plast Surg

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Background:The management of advanced cutaneous malignancies has been controversial. Thirteen patients with nonmelanoma skin neoplasias that had invaded the bone of the calvarium and scalp were treated in our centre.Objective:The purpose of this study was to evaluate our experience in treating these malignancies with scalp resection and full or partial thickness cranium reconstruction.Patients and Methods:From June 2008 to March 2012, thirteen patients with locally advanced tumours of the scalp invading the calvarium were treated with wide local excision of the scalp combined with an underlying craniectomy and dural resection if needed.Results:Using histopathological diagnosis eleven patients were diagnosed with basal cell carcinoma and two patients with squamous cell carcinoma. A full thickness cranium resection was performed in seven patients and partial in six patients.Conclusion:These large cancers occasionally invade adjacent structures, as well as bone, presenting a challenging surgical problem. In general, giant rotational or island scalp flaps and free tissue transfers are needed to close the area. Finding clean margins are an important part of treating patients with bone involvement and can usually be attained using outer tabula curettage thus preventing unnecessary morbidity.

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“…In complex cases, only well-vascularized free-tissue transfer can meet both structural and protective requirements, albeit resulting in a hairless reconstruction. 4,25 The advent of reconstructive microsurgery has allowed single stage, complete scalp reconstruction using distant tissue, and can be performed at the time of tumor extirpation. Consequently, numerous free flaps have been described for scalp reconstruction, including free omentum flap with skin graft, 26,27 groin flap, 1 LD muscle or musculocutaneous flap, 7-10 radial forearm flap, [28][29][30][31] rectus abdominis flap 19 and ALT flap.…”

Section: Discussionmentioning

confidence: 99%

“…Free tissue transfer is often required for large complex defects of the scalp including those with infection, radiation damage, bone loss or prosthesis exposure. [1][2][3][4] Although the latissimus dorsi (LD) muscle or musculocutaneous free flaps are acceptable alternative, 2,5-10 the main disadvantage is of the limited skin paddle, need for skin grafts and significant atrophy of muscle, which lead to palpable or exposed hardware. Alternatives such as the scapular flap, rectus abdominis flap and radial forearm flaps have been described but is limited to smaller sized defects.…”

mentioning

confidence: 99%

The role of the anterolateral thigh flap in complex defects of the scalp and cranium

et al. 2013

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In this study, we introduced scalp reconstruction using free anterolateral thigh (ALT) flaps and evaluated postoperative outcomes in nine patients between March 2000 and April 2012. Five patients had problems of exposed prosthesis, three required reconstruction after resection of scalp tumor and one patient presented with third degree flame burns of the scalp. All flaps survived without re-exploration, except three flaps with tip necrosis requiring secondary procedures of debridement and small Z-plasty reconstructions. The superficial temporal artery and its concomitant vein were used as recipient vessels, apart from two cases where previous surgery and flame burns excluded these choices, for which facial arteries and veins were used instead. Primary closure of the donor-site was possible in six cases; with skin grafting performed for the other three patients. All donor sites healed without complications. The ALT flap offers the advantage of customizable size, option of fascia lata as vascularized dural replacement, and minimal flap atrophy typical of muscle flaps. Indications include very large defects, defects with exposed prosthesis, or defects with bone or dural loss. Our experience lends credible support to the use of customized free ALT flaps to achieve functional and cosmetically superior result for the reconstruction of large scalp defects, especially with bone exposure.

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Scalp, Skull, and Dura Reconstruction on an Emergency Basis

Cited by 12 publications

References 0 publications

Emergency microsurgery for patients with soft tissue, skull, and dura complex defects after trauma: a case report

Emergency microsurgery for patients with soft tissue, skull, and dura complex defects after trauma: a case report

The management of non-melanocytic skin malignancies of the scalp and calvarium

The role of the anterolateral thigh flap in complex defects of the scalp and cranium

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