Treatment of Large and Complicated Scalp Defects with Free Flap Transfer.

Fanfan Chen,Hongbin Ju,Xinliang Wang,Yongfu Cao,Yongjun Yi,Guo Fu,Anfei Huang,Wei Xie

doi:10.1155/2020/2748219

Abstract

Background Large scalp defects, especially those complicated by calvarial defects, titanium mesh exposure, or cerebrospinal fluid (CSF) leak, pose a challenge for the neurosurgeon and plastic surgeon. Here, we describe our experience of reconstructing the complex scalp defect with free flap transfer. Methods From October 2012 to September 2017, 8 patients underwent free flap transfer for the reconstruction of the scalp or complicated scalp and calvarial defects. Five patients presented with scalp tumor and the other 3 patients with scalp necrosis or ulceration (2 patients with titanium plate exposure). Seven anterolateral thigh flaps and one radial forearm flap were harvested and employed. The clinical data, including defect characteristics, flap type, complications, and outcomes, were recorded and analyzed. Results Five patients were pathologically diagnosed with malignant tumor, and 3 of them were given further radiotherapy. For the 2 patients with exposure of titanium plate, no titanium plate was removed. For the patient with scalp necrosis after decompressive craniectomy accompanied by CSF leakage, the CSF leak was stopped after reconstruction. The size of the flaps ranged from 3 to 14 cm in width and 4 to 18 cm in length. No flap failure occurred in these cases. From follow-up to the present, no ulceration or necrosis occurred. Conclusions Free flap transfer is an ideal method for the reconstruction of large, complicated scalp defects with a one-stage operation. The anterolateral thigh flap is favored because of its durability, adjustability, water tightness, and infection prevention.

Highlights

Large scalp defects are usually secondary to a variety of diseases, such as tumor resection, trauma, infection, and congenital lesions [1, 2]
Two patients presented with ulcer of the scalp with titanium plate exposure (Figure 2(d)). e remaining 1 patient had scalp necrosis after decompressive craniectomy accompanied by cerebrospinal fluid (CSF) leakage. e area of the defect was located in the forehead region (1 case), the frontoparietal region (1 case), the frontal region (1 case), the lateral occipital region (1 case), the parietal to occipital region (2 cases), and the temporal region (2 cases)
Ree patients were treated with further radiotherapy, and the other 2 patients refused radiotherapy. e anterolateral thigh (ALT) flaps were used in 7 patients, and the radial forearm flap was employed in 1 case

Summary

Introduction

Large scalp defects are usually secondary to a variety of diseases, such as tumor resection, trauma, infection, and congenital lesions [1, 2]. There is a lack of consensus regarding which procedure is superior in large and complicated scalp reconstruction. In this retrospective study, we present our experience with the reconstruction of scalp defects with free flap transfer. E. Large scalp defects, especially those complicated by calvarial defects, titanium mesh exposure, or cerebrospinal fluid (CSF) leak, pose a challenge for the neurosurgeon and plastic surgeon. From October 2012 to September 2017, 8 patients underwent free flap transfer for the reconstruction of the scalp or complicated scalp and calvarial defects. Free flap transfer is an ideal method for the reconstruction of large, complicated scalp defects with a one-stage operation. Free flap transfer is an ideal method for the reconstruction of large, complicated scalp defects with a one-stage operation. e anterolateral thigh flap is favored because of its durability, adjustability, water tightness, and infection prevention

Methods

Results

Conclusion