Author(s): Saima Ayub,1 Farid Ahmad Khan,2 Sana Saeed,3 Usman Ghani,4 Mamona Sadiq,5 Sara Riaz6
Received: 07/07/2023 | Published: 31/10/2023 | Pages: 52-56 |
Background: Scalp and forehead reconstruction is required after trauma, burns, oncological resection, and cutaneous infections. The scalp is a unique part of the human body, and its inherent anatomy presents challenges in the reconstruction of large defects. The goals of scalp reconstruction are well-vascularized soft tissue coverage, intact calvarium and an aesthetically pleasure appearance. The use of locoregional flaps for reconstruction allows for rapid recovery and shorter operative time.
Methodology: This retrospective observational study was conducted at the Department of Plastic Surgery and Burns Unit, Services Institute of Medical Sciences, Lahore. Twenty-five patients requiring scalp and forehead reconstructions were studied between January 2020 and January 2022. Demographic data, defect etiology, location and size of the defect, comorbidities, and type of flap used for reconstruction were also documented. The primary outcomes assessed were wound healing, operative time and length of hospital stay. The secondary outcome was complications (early and late). Data were analyzed using SP S S version 26.0.
Results: Among the 25 patients, 17 were male and 8 were female. The mean patient age was 40 ± 12 years. Seven patients underwent scalp rotation-advancement flap, 2 underwent scalp rotation along with forehead advancement flap, 3 underwent scalp rotation along with trapezius myoocutaneous flap, 10 underwent transposition flap, and 3 underwent double transposition flap. The most common etiology of the defect was tumor extirpation (n=13), followed by trauma (n=7), radionecrosis (n=3), and electric burn (n=2) (Figure 2). The temporal site was the most common site of the defect (n=8). The mean scalp defect (area) was 90 ± 31 cm2. The mean operative time was 137 ± 9.6 minutes and the mean hospital stay was 5.96 ± 0.8 days. Wound healing on the 7th postoperative day was 94 ± 0.9%. Two patients developed small hematoma. One patient developed a distal flap necrosis.
Conclusion: Locoregional flaps can be a reliable option for reconstruction of large scalp and forehead defects.
Keywords: scalp and forehead defects, reconstruction, wound healing, patient’s satisfaction, loco-regional flaps
- Aslam M, Rashid M, Illahi I, Haq E, Sarwar S. Reconstruction of Scalp Defects with Free Flaps. PAKISTAN JOURNAL OF PLASTIC SURGERY. 2013:26.
- Lutz B, Wei F, Chen H, Lin C, Wei C. Reconstruction of scalp defects with free flaps in 30 cases. British Journal of Plastic Surgery. 1998;51(3): 186-90.
- Lee B, Bickel K, Levin S. Microsurgical reconstruction of extensive scalp defects. Journal of reconstructive 1999 ; 15 (04):255-62.
- Frimpong P, Nguyen TTH, Nimatu ES, Amponsah EK, Kim SM. Scalp injury management by a maxillofacial surgeon in a low-resource hospital. Maxillofacial Plastic and Reconstructive Surgery. 2020;42(1):1-5.
- Jibbe A, Tolkachjov SN. An efficient single-layer suture technique for large scalp flaps. Journal of the American Academy of Dermatology. 2020;83(6):e395-e6.
- Costa DJ, Walen S, Varvares M, Walker R. Scalp rotation flap for reconstruction ofcomplex soft tissue defects. Journal of Neurological Surgery Part B: Skull Base. 2016;77(01):032-7.
- Yu P, Yu N, Yang X, Jin X, Lu H, Qi Z. Clinical efficacy and safety of negative-pressure wound therapy on flaps: a systematic review. Journal of Reconstructive Micro 2017;33(05):358-66.
- Othman S, Shakir S, Azoury SC, Lukowiak T, Shin TM, Sobanko JF, et al. Utility of dermal wound matrices compared with local-tissue rearrangement and free flap reconstruction for oncologic scalp wounds: a multidisciplinary dual matched-pair analysis. Plastic and Reconstructive Surgery. 2022;149(2):469-80.
- Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plastic and reconstructive surgery. 2005;116(4):54e-72e.
- Netolizky, J. Zur Kasuisitik der Hauttransplantation Wien Med . Wochenshr. 21:820,1871
- Robinson, E.F. Total avulsion ofthe scalp. Surg Gynecol. 7:663, 1908.
- Kazanjian VH, Holmes EM. Reconstruction after radical operations for osteomyelitis of the frontal sinus. Surg Gynexol Obstct. 1944;79:397
- Mclean DH, Bunike HJ. Autotransplant of omentum to a large scalp defect, with microsurgical revasculari Plasta Reconstr Surg. 1972;49(3): 268-74
- Zayakova Y, Stanev A, Mihailov H, Pashaliev N. Application of local axial flaps to scalp reconstruction. Archives ofplastic surgery. 2013;40(05):564-9.
- Raposio E, Santi PL, Nordstrom RE. Serial scalp reductions: a biomechanical approach. Dermatologic surgery. 1999;25(3):210-4.
- Zenga J, Sharon JD, Santiago P, Nussenbaum B, Haughey BH, Fox 1K, et al. Lower trapezius flap for reconstruction of the posterior scalp and neck defects after complex occipital-cervical surgeries. Journal of Neurological Surgery Part B: Skull Base. 2015;76(05):397
- Tanaka K, Sakuraba M, Miyamoto S, Hayashi R, Ebihara M, Miyazaki M, et al. Analysis of operative mortality and post-operative lethal complications after head and neck reconstruction with free tissue transfer. Japanese Journal of clinical oncology. 2011 ;41 (6): 758-63 .
- Beasley NJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, Neligan PC. Scalp and forehead reconstruction using free revascularized tissue transfer. Archives of facial plastic surgery. 2004.
- Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP. Factors associated with complications in microvascular reconstruction of head and neck defects. Plastic and reconstructive surgery. 1999;103(2):403
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