An Algorithm for Oncologic Scalp Reconstruction

Iblher, Niklas; Ziegler, Matthias C.; Penna, Vincenzo; Eisenhardt, Steffen U.; Stark, G. Björn; Bannasch, Holger

doi:10.1097/prs.0b013e3181e09515

Cited by 82 publications

(102 citation statements)

References 29 publications

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“…Cranial bone infection was also classified as a major complication and treated by removing the infected bone flap, followed by reconstruction using either a free muscle flap or omental flap. 2,9,[15][16][17][18][19]24 When planning scalp reconstructive surgery after revascularization surgery, surgeons should consider some important points. The route of the vessel used in the primary surgery should be confirmed before surgery in order to avoid damage.…”

Section: Discussionmentioning

confidence: 99%

Operative wound-related complications after cranial revascularization surgeries

Takanari

Araki²,

Okamoto³

et al. 2015

JNS

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aBBreViatiONS BA = basilar artery; DM = diabetes mellitus; EDAMS = encephalo-duro-arterio-myo-synangiosis; EDAS = encephalo-duro-arterio-synangiosis; EMS = encephalo-myo-synangiosis; ICA = internal carotid artery; MCA = middle cerebral artery; MMD = moyamoya disease; SCA = superior cerebral artery; SPECT = singlephoton emission computed tomography; STA = superficial temporal artery; STSG = split-thickness skin graft. SuBmitted January 13, 2014. accepted December 5, 2014. iNclude wheN citiNg Published online July 3, 2015; DOI: 10.3171/2014.12.JNS132602. diSclOSure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. * Drs. Takanari and Araki contributed equally to this work. OBJect Intracranial revascularization surgeries are an effective treatment for moyamoya disease and other intracranial vascular obliterative diseases. However, in some cases, wound-related complications develop after surgery. Although the incidence of wound complication is supposed to be higher than that with a usual craniotomy, this complication has rarely been the focus of studies in the literature that report the outcomes of revascularization surgeries. Here, the relationship between intracranial revascularization surgeries and their complications is statistically assessed. . Multivariate logistic regression analysis also revealed that double procedures demonstrated a significantly higher incidence of wound complications than single procedures (OR 3.087, p = 0.048). DM was found to be a risk factor for wound complication (OR 9.42, p = 0.02), but age, sex, hypertension, and hyperlipidemia were not associated with the incidence of complications. Even though the blood supply to the scalp is abundant due to 5 arteriovenous systems, sometimes cutaneous necrosis develops after intracranial revascularization surgeries. The galeal blood supply is thought to be crucial for preventing wound-related complications. Special care is also thought to be required for DM patients. cONcluSiONS Revascularization surgeries seemed to demonstrate a higher risk of wound-related complications. Double-type procedures, which use both branches of the STA, and a history of DM were found to be risk factors for wound-related complications. Attention should be paid to the design of the galeal incision and vessel harvest line. Also, special attention should be paid to patients with DM.http://thejns.org/doi/abs/10.3171/2014.12.JNS132602KeY wOrdS cranial revascularization surgery; extracranial to intracranial bypass; infection; skin necrosis; superficial temporal artery-to-middle cerebral artery anastomosis; wound-related complication; vascular disorders 1145

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Section: Discussionmentioning

confidence: 99%

Operative wound-related complications after cranial revascularization surgeries

Takanari

Araki²,

Okamoto³

et al. 2015

JNS

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“…The medium sized defects between 2 cm 2 and 25 cm 2 or in another terms the defects between 3-4 cm and 6-8 cm diameter, cannot be closed primarily and requires skin grafts, local rotation or advancement flaps or staged procedures by means of tissue expanders. In order to close the larger defects as in our study, serial tissue expansions, regional flaps especially for occipital defects and free flaps can be used (7,9).…”

Section: Discussionmentioning

confidence: 96%

“…Regional nonadjacent tissue transfer techniques are limited to very specific indications and specific locations (7).…”

Section: Discussionmentioning

confidence: 99%

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Use of scalp flaps as a salvage procedure in reconstruction of the large defects of head and neck region

Egemen

Bingöl²,

Özkaya³

et al. 2012

Turkish Neurosurgery

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ABSTRACTaIM: Large defects of the scalp, head and neck region are often encountered by plastic surgeons. The repair of such defects is dependent upon their location, size and depth. This study describes the use of large scalp flaps as a salvage procedure in the reconstruction of large scalp, head and neck region defects in elderly patients with poor general condition or advanced malignancy. MaterIaL and MetHOds:The presented study includes 22 patients operated between 2007 and 2011 for the reconstruction of large defects of the hair-bearing skin and head/neck region with large scalp flaps. A defect exceeding 25 cm 2 area was classified as "large" as defined in the previous studies. The patients' medical records were analyzed. resuLts: Scalp flaps provided a satisfactory and durable reconstruction in the late follow-up term. All flaps were completely survived except in one case in which a partial necrosis in the distal margin occurred. Major complications were recorded in 4.5% of patients while minor complications were recorded in 13.5% of them. cOncLusIOn:In conclusion, large scalp flaps should be considered as a salvage procedure for reconstruction of large scalp, head and neck defects especially for palliative situations in elderly patients with significant comorbidities and advanced malignancies. sOnuÇ: Sonuç olarak, geniş skalp flepleri, ciddi komorbiditesi olan veya ileri kanser olgularında, yaşlı hastalarda özellikle palyatif durumlarda, geniş skalp ve baş boyun bölgesi defektlerinin rekonstrüksiyonunda, kurtarıcı bir posedür olarak dikkate alınmalıdır.anaHtar sÖZcÜkLer: Skalp defekti, Geniş skalp flebi, Baş ve boyun defekti, Skalp rekonstrüksiyonu, Baş ve boyun rekonstrüksiyonu, Saçlı deri defekti

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“…A recent study by Iblher et al 19 of 60 patients with scalp tumors gathered over a 10-year period was reported on. Basal cell carcinoma dominated their series while squamous cell carcinoma was the commonest diagnosis seen in our patients.…”

Section: Discussionmentioning

confidence: 99%

Skull Base Surgery for the Management of Deeply Invasive Scalp Cancer

et al. 2011

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Skin cancer involving the scalp is a common malignancy in the ''sun belt areas of the United States.'' Most early lesions are well managed by primary care physicians and dermatologists. Occasionally we encounter basal cell, squamous cell, and rarely Merkel cell carcinomas that have failed local therapy and present with large tumors invading full thickness scalp, calvarium, and even underlying dura. We describe our experience with 52 such tumors and illustrate their resections and reconstruction. For full thickness lesions we generally do a wide field resection of skin and underlying calvarium followed by dural resection. Reconstruction is usually with dural replacement, calvarial reconstruction with titanium mesh, and cutaneous reconstruction with a musculocutaneous free flap or muscular free flap with an overlying skin graft. Complications, survival rates, and recurrence rates will be presented.

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An Algorithm for Oncologic Scalp Reconstruction

Cited by 82 publications

References 29 publications

Operative wound-related complications after cranial revascularization surgeries

Operative wound-related complications after cranial revascularization surgeries

Use of scalp flaps as a salvage procedure in reconstruction of the large defects of head and neck region

Skull Base Surgery for the Management of Deeply Invasive Scalp Cancer

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