Abstract
BackgroundReconstruction of large scalp defects after tumor resection is a challenging problem. We aimed at putting an algorithm for reconstruction of those defects.MethodsForty-two patients with scalp malignancies were enrolled in this study. Tumors were resected to a 1 cm negative margin and defects were reconstructed according to their size and to patient general condition.ResultsNo peri-operative mortality was encountered. Usage of free flaps was superior in cosmoses and function with an acceptable rate of complications.Conclusionfor scalp defects wider than100 cm2, the best tool of reconstruction is free flaps. Pedicled distant flaps are reserved if free flaps are not feasible or failed. Split thickness skin grafts are cosmetically inferior and not suitable for recurrent and irradiated tumours and better reserved for patients who cannot tolerate major operations.
Highlights
Reconstruction of large scalp defects after tumor resection is a challenging problem
An infiltrated lateral margin was encountered in four cases and was treated by wider excision
In three cases there was infiltration of the deep margin that was treated by excision of part of the skull with the aid of a neurosurgical team
Summary
Reconstruction of large scalp defects after tumor resection is a challenging problem. Tumor resection may be a complex procedure when there is clavarial bony involvement that requires the attendance of a neurosurgeon. Another issue is the cosmetic appearance which mandates the use of hairy tissue. Associated co-morbid conditions especially cardiac disorders among elderly patients, who constitute a large category of cases with scalp tumors, Reconstruction can be either immediate after obtaining free margins by frozen section or delayed after waiting for the results of paraffin section [4]. The use of tissue expansion allows a larger area of coverage with satisfactory results, it has limitations for size coverage and it is not free of morbidities [6]
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