Background: Reconstruction of Scalp defects is a challenging problem. The unique hair bearing characteristics of scalp impose unique reconstructive challenges for coverage of scalp defects. Size, location and depth of the defect determine the complexity of the procedure. Patients with large scalp defects require reconstruction with broad based large scalp flaps. Objective: To determine the outcome of use of bipedicle scalp flap for coverage of large scalp defects.

We present a case report of 30-year female presenting with a large skin and soft tissue defect of anterior chest wall, after bilateral mastectomy. Unlike other patients, she also had sternum defect after resection of skin of sternum. She had a 34x17 cm defect of anterior chest when she presented to us. We covered the defect and reconstructed bilateral breasts all with a single paddle bilateral delayed Transverse Rectus Abdominus Myocutaneous (TRAM) flap. Our flap paddle measured 42x21 cm and we observed no tip necrosis.

Introduction: The objective of this work is to determine the role of a multidisciplinary approach in treating the complex high flow head and neck arteriovenous malformations (AVMs), involving radiologists and plastic surgeons for the best possible outcomes. Methods: Between 2018 and 2020, the investigators conducted a retrospective analysis on seven patients with high-flow head and neck AVMs who received treatment at a tertiary care facility. Age at first diagnosis, presenting features, prior therapies, endovascular treatment, surgical treatment, and therapeutic outcomes were all recorded. A comparison of pre-and post-procedure pictures was made to assess the clinical outcomes for all patients. Results: Seven patients with complex high flow head and neck AVMs were jointly managed by performing plastic surgery and interventional radiology. There were male and female, with an average age of 24 years. Each patient underwent embolization followed by surgical resection within a 24-hour window of up to 72 hours. In six out of seven patients, the lesion was removed therapeutically, whereas the seventh required palliative resection. Only one patient, there was a minor wound healing difficulty able to be treated with dressings. Conclusion: The results revealed that embolization alone is not effective to reduce the adverse effects. Incomplete removal of AVM showed the same effect as incomplete removal of a tumour. It may not improve symptoms and may worsen the recurrence, thus multi-modality approach is beneficial. A multidisciplinary approach, aided by the interventional radiologist and enable plastic surgeons to remove the high-flow AVMs effectively.