Abstract
Although most small to medium defects of the scalp can be covered by local flaps, large defects or complicating factors, such as a history of radiotherapy, often require a microsurgical reconstruction. Several factors need to be considered in such procedures. A sufficient preoperative planning is based on adequate imaging of the malignancy and a multi-disciplinary concept. Several flaps are available for such reconstructions, of which the latissimus dorsi and anterior-lateral thigh flaps are the most commonly used ones. In very large defects, combined flaps, such as a parascapular/latissimus dorsi flaps, can be highly useful or necessary. The most commonly used recipient vessels for microsurgical scalp reconstructions are the superficial temporal vessels, but various other feasible choices exist. If the concomitant veins are not sufficient, the jugular veins represent a safe back-up alternative but require a vessel interposition or long pedicle. Post-operative care and patient positioning can be difficult in these patients but can be facilitated by various devices. Overall, microsurgical reconstruction of large scalp defects is a feasible undertaking if the mentioned key factors are taken into account.
Highlights
The scalp covers the calvarium and consists of skin, subcutaneous tissue, the galea aponeurotica, loose areolar tissue, and the pericranium
A sufficient preoperative planning is essential for an extensive surgical procedure, such as the oncological resection and microsurgical reconstruction of malignancies of the scalp
The wide resection is still commonly recommended in sarcoma surgery, such an approach would render most of the sarcomas of the scalp to be considered not resectable
Summary
Ole Goertz1* , Leon von der Lohe , Ramón Martinez-Olivera , Adrien Daigeler , Kamran Harati , Tobias Hirsch , Marcus Lehnhardt and Jonas Kolbenschlag. Most small to medium defects of the scalp can be covered by local flaps, large defects or complicating factors, such as a history of radiotherapy, often require a microsurgical reconstruction. Several flaps are available for such reconstructions, of which the latissimus dorsi and anterior-lateral thigh flaps are the most commonly used ones. In very large defects, combined flaps, such as a parascapular/latissimus dorsi flaps, can be highly useful or necessary. The most commonly used recipient vessels for microsurgical scalp reconstructions are the superficial temporal vessels, but various other feasible choices exist. If the concomitant veins are not sufficient, the jugular veins represent a safe back-up alternative but require a vessel interposition or long pedicle. Microsurgical reconstruction of large scalp defects is a feasible undertaking if the mentioned key factors are taken into account
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