Fibonacci sequence ‘snail’ flap versus skin grafts in scalp reconstruction: a comparative study

Abstract

Scalp defects commonly occur as a result of tumour excision or trauma. The reconstruction of medium to large defects can be challenging due to the scalp laxity and hair growth pattern. We compare the outcome of patients who have had snail flap reconstruction in comparison to skin grafts. We conducted a retrospective case study of 45 consecutive patients’ over a 3-year period (2016–2018), across three sub-groups, viz. Fibonacci sequence flap, split skin graft and full-thickness skin grafts. The sub-cohorts were all matched for age, sex, indications and defect sizes before being analysed in terms of complication rates and wound healing rates over a 4-month period. The Fibonacci ‘snail’ flap was found to heal significantly faster than the full-thickness skin graft group and with lower complication rates overall, compared to skin grafts, but the latter outcome did not reach statistical significance. The aesthetic outcome of the Fibonacci flap though was superior to skin grafts both in terms of colour and contour match as well as hair restoration. The Fibonacci ‘snail’ flap is a sound option for the reconstruction of medium to large size defects of the scalp, even in those with poor performance scores, especially since its lower flap: defect ratio allows it to be performed under local anaesthesia. The advantage of the ‘snail’ flap over other scalp flaps will be determined in a future comparative study. Level of evidence: Level III, therapeutic study.