Reconstruction of upper cranial and cranial base defects utilizing the scalping flap.

Abstract

Reconstruction of midfacial defects by means of a scalping flap has been widely practiced and described in the literature. The advantages of the flap are familiar to surgeons who perform extirpations and reconstruction of the head and neck and include contiguous availability, simplicity of application, and a robust and redundant blood supply. Despite these merits, the flap has not been widely used for reconstructions of large anterior cranial defects or defects of the cranial base. A retrospective review of 11 patients who underwent reconstructions between 1990 and 1995 was performed. In each case, a reconstruction of a large anterior cranial or cranial base defect was carried out. The resulting soft-tissue defect was restored via the scalping flap. In six cases, this was carried out in a single procedure. In five cases, flap division and insetting were carried out in a subsequent procedure, following a 1- to 2-week delay. In all cases, the extirpation and reconstruction were well tolerated, and the average time of hospitalization was 5.9 days and ranged from 3 to 11 days. No major surgical complications occurred. One of 11 patients had a minor complication not requiring surgical intervention. There was one recurrence of a cranial base tumor approximately 2 years following the initial resection and reconstruction. In all cases, the final aesthetic and functional results were acceptable to excellent. Follow-up ranged from 11 months to 5 years. In conclusion, the scalping flap can be effectively utilized for soft-tissue coverage in the reconstruction of anterior cranial and cranial base defects. Use of this simple and versatile flap in craniofacial reconstruction is well tolerated and is associated with a low morbidity, a good aesthetic result, and a short hospital stay.