Reliability of Loco Regional Flaps in Reconstruction of Large Scalp and Forehead Defects

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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