Secondary Expansion of a Totally Replanted Scalp for Aesthetic Adjustment

Maladry, David; Brabant, Bruno; Berard, V.; Dupuis, P V; Mitz, V.

doi:10.1097/00006534-199412000-00021

Cited by 8 publications

(7 citation statements)

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“…Reconstruction of complex scalp defects after oncologic resection can present difficulties regarding functional and aesthetic outcomes. The reconstructive outline of scalp defects includes primary closure, split-thickness skin grafts, local and regional flaps, and tissue expanders [8][9][10][11]. Ideally, a like-to-like reconstruction is desirable.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps

Vera

Cuéllar²,

Cuéllar³

et al. 2021

JCM

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Microsurgical scalp reconstruction is indicated in patients with large scalp defects. The aim of this study was to compare the outcomes of scalp reconstruction in oncologic patients reconstructed with latissimus dorsi (LD), anterolateral thigh (ALT), and omental (OM) free flaps. Thirty oncologic patients underwent scalp reconstruction with LD (10), ALT (11), and OM (9) flaps. The length of the vascular pedicle, the operation time, the possibility of a two-team approach, the length of hospital stays, the complications, and the aesthetic results were evaluated. The OM flap was the flap with the shortest vascular pedicle length with a mean of 6.26 ± 0.16 cm, compared to the LD flap, which was 12.34 ± 0.55 cm and the ALT flap with 13.20 ± 0.26 cm (p < 0.05). The average time of surgery was 6.6 ± 0.14 h in patients reconstructed with OM, compared to the LD flap, which was 8.91 ± 0.32 h and the ALT flap with 7.53 ± 0.22 h (p < 0.05). A two-team approach was performed in all patients for OM flaps and ALT flaps, but only in two patients reconstructed with the LD flap (p < 0.001). In patients reconstructed with the OM flap, a very satisfactory or satisfactory result was reported in seven patients (77.8%). Eight patients reported a very unsatisfactory or unsatisfactory result with LD flap (80%) and 10 patients with ALT flap (90.9%) (p = 0.002). The mean hospital stay after surgery was not statistically significant (p > 0.05). As for complications, two patients reconstructed with OM flap, five LT flaps, and two ALT flaps developed complications, not statistically significant (p = 0.235). Omental flap, latissimus dorsi flap, and anterolateral thigh flap fulfill most of the characteristics for complex scalp reconstruction. The decision on which flap to use should be based on clinical aspects of the patients taking into account that the three flaps show similar rates of complications and length of hospital stay. Regarding the aesthetic outcome, OM flap or LD flap should be considered for reconstruction of extensive scalp defects.

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Section: Discussionmentioning

confidence: 99%

Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps

Vera

Cuéllar²,

Cuéllar³

et al. 2021

JCM

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“…1 Literature about successful microsurgical scalp replantation is usually limited to sporadic case reports. [5][6][7][8][9][10][11][12][13][14][15][16][17] The largest series consisted of 20 cases, which was reported by Cheng et al in 1996. 18 The major blood supply of the scalp comes from the superficial temporal and occipital arteries.…”

Section: Discussionmentioning

confidence: 99%

Replantation of Total Avulsed Scalp With Microsurgery: Experience of Eight Cases and Literature Review

Yin

Matsuo

Hsieh

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Successful replantations can achieve the best esthetic and functional results compared with other procedures. Scalp amputations sustained from sharp cuts seem to be quite as common as hair traction injuries. Such amputation injuries were more common in male patients with short hair. The manner of injury often will influence planning during replantation. Even if the amputated scalp was crushed or contaminated, such as those sustained from animal bites, replantation should still proceed, unless a greater contraindication exists.

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“…However, this type of positioning is not always possible, and sometimes the expander needs to be placed in the same plane as the pedicle. In a case comparable to a free flap, Maladry et al 2 placed an expander directly beneath a replanted scalp. They started expansion at 10 months post-revascularisation without any complications.…”

Section: Discussionmentioning

confidence: 99%

“…Tissue expansion is a well established method in reconstructive surgery. [1][2][3][4][5][6][7] It is commonly used to expand healthy skin for coverage of adjacent diseased areas in need of excision. Common applications are correction of burn scars and contractures [8][9][10][11] excision of nevi or hemangioma in children, reconstruction of the hair bearing scalp, 12 and in breast reconstruction.…”

mentioning

confidence: 99%

Tissue Expansion of Free and Pedicled Flaps after Transfer: Possibilities and Indications

Baumeister

Follmar

Erdmann

et al. 2007

J reconstr Microsurg

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Tissue expansion in combination with flap transfer has been widely reported as preexpansion of flaps, but only once as expansion of a free flap after transfer. Three free flaps and one pedicled flap were expanded after transfer. Indication, timing of expander implantation and explantation, technical aspects, and complications are reviewed. Indications for expander implantation after flap coverage were adjacent scar contracture, a secondary ulcer, or correction of contour deformity. The expander was placed as early as 4.5 months after free flap transfer. Low grade infection and seroma were complications necessitating early expander removal in two cases. The outcome was satisfactory in all four patients. Tissue expansion after flap transfer has been shown to be a reliable reconstructive option in selected cases. Indications are rare and include hypertrophic scar formation, scar contracture, secondary ulceration, or reconstructive procedures. In early free flap expansion, it is critical to avoid mechanical pressure of the pedicle. In musculocutaneous flaps, this can be accomplished by placing the expander subcutaneously. If more than 6 months have passed since transfer of the flap, the randomized blood supply is sufficient to place the expander anywhere under the flap.

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Secondary Expansion of a Totally Replanted Scalp for Aesthetic Adjustment

Cited by 8 publications

References 0 publications

Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps

Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps

Replantation of Total Avulsed Scalp With Microsurgery: Experience of Eight Cases and Literature Review

Tissue Expansion of Free and Pedicled Flaps after Transfer: Possibilities and Indications

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