Application of the pinwheel flap for closure of a large defect of the scalp

Varnalidis, Ioannis; Mantelakis, Angelos; Spiers, Harry; Papadopoulou, Athina

doi:10.1136/bcr-2019-229420

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…In addition, due to the skin's lack of elasticity in the area, high stresses in the soft tissue lead to a high probability of ischemic complications. Therefore, the option of postoperative tissue edema can be prevented by proper attenuation for tight tension closure and proper suture placement (22,23).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Scalp Basal Cell Carcinoma UsingPinwheel Flap: A Case Report

Soltaninia

Ebrahimifard

Soleimani

2022

Avicenna J Dent Res

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Ideal reconstruction of the scalp should ensure adequate coverage and protection of the underlying areas of the reconstruction site, include an adequate volume of soft and hard tissue, and contour the reconstruction of the area to accelerate wound healing, acceptable beauty, and proper function and reduce complications after the operation. This study aimed to present our experience regarding basal cell carcinoma (BCC) in the scalp and show the reconstructive option for BCC cancer in the scalp. A 69-year-old man was admitted due to the recurrence of the lesions in the forehead and scalp area, and he underwent surgery again one year ago. On initial examination, a lesion sized 5 cm× 5cm with an indistinct margin was visible in the frontal region. The lesion had bleeding, itching, and purulent discharge. Computed tomography scan results indicated skull bone resorption, and pathologic report showed active ulcer BCC with infiltrative growth pattern widely disseminated in deep portion. Tumor size was 4.5 cm × 4.3 cm × 1.5 cm and was negative for lymphovascular invasion. The patient was organized for wide local excision of the lesion. Following the tumor resection, the remaining oval defect was reconstructed using the pinwheel flap under general anesthesia in the operating room. It seems that the pinwheel flap design is an effective approach for the reconstruction of extensive lesions of the scalp.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of Scalp Basal Cell Carcinoma UsingPinwheel Flap: A Case Report

Soltaninia

Ebrahimifard

Soleimani

2022

Avicenna J Dent Res

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“…Due to an increasing prevalence of cutaneous neoplasms in the United States, there is an increased focus on reconstructive techniques for skin defects, particularly in cosmetically‐sensitive areas like the head and neck 15 . Current reconstructive algorithms recommend that defects larger than 30 cm 2 be repaired with free tissue transfer alone or the addition of skin grafts to a local flap 1,3,10,12,16,17 . To our knowledge, this is the largest case series that demonstrates the use of O‐Z flaps for the reconstruction of scalp defects as large as 63 cm 2 following tumor resection.…”

Section: Discussionmentioning

confidence: 99%

“…No randomized trials exist in the literature for comparing the effectiveness of local flap and free flap approaches for large scalp defects. Some recent case reports have demonstrated the use of the Orticochea flap for large frontal or vertex scalp defects 16,17 . Given the various factors that contribute to outcomes with different reconstructive techniques, further studies are required to understand the independent risks and optimize the selection criteria for these approaches.…”

Section: Discussionmentioning

confidence: 99%

Use of the O‐Z flap as an alternative to free tissue transfer for reconstruction of large scalp defects

Cao

Carey

Shah

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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Objective: The reconstruction of large scalp defects poses both functional and cosmetic challenges. While free tissue transfer remains the standard for defects larger than 30 cm 2 , prolonged anesthesia and postoperative complications remain significant limitations. The purpose of this study is to evaluate the use of O-Z flaps for the reconstruction of large scalp defects and to describe the techniques employed.Methods: This is a retrospective analysis of ten patients who underwent reconstructive surgery using an O-Z flap approach for large scalp defects between July 2017 and June 2019. The parameters included in this study were patient demographics, tumor characteristics, and postoperative management, collected for at least a year after surgery.Results: In this cohort, the mean age was 76.1 years and 90% were male. All patients were treated for neoplastic skin lesions, with 70% located on the vertex and 30% located on the temporoparietal region. The mean size of defect was 52.0 cm 2 (range: 38.6 to 63.8 cm 2 ). The maximum hospital stay was two days, and no patients were readmitted within 30 days of surgery. There were no cases of wound infection or flap necrosis. All patients reported pain control with acetaminophen and ibuprofen.Four patients received adjuvant radiation, and there was no delay to receiving treatment following surgery. Conclusions:The O-Z flap is a reliable alternative for the reconstruction of nonirradiated scalp defects in the vertex and temporoparietal regions up to 63 cm 2 . This technique provides advantages for patients, including hairline preservation, shorter hospital stays, and decreased postoperative complications.

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“…An alternative, not present in our review, may be represented by a primary reconstruction with skin grafting followed by delayed, subgaleal 34 or external, 35 scalp expansion in case of wide defects or necessity to wait for safe monitoring. Local flaps, in fact, are successfully employed in small (<50 cm 2 ) defects, 12 , 16 , 24 , 25 , 27 whereas they need association with skin grafts in case of wider wounds. 25 Another easy and oncologically safe option is represented by skin-grafted local galeal flaps.…”

Section: Discussionmentioning

confidence: 99%

Surgical Reconstruction following Wide Local Excision of Malignant Melanoma of the Scalp

Baldelli

Mangialardi

Salgarello

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Scalp reconstruction in cases of melanoma excision can be challenging due to specific functional and aesthetic outcome requirements. Reconstructive techniques reported in the literature were reviewed to establish whether a surgical algorithm for the management of melanoma of the scalp may be deduced. Methods: A literature search was conducted to evaluate reconstructive strategies after melanoma wide local excision of the scalp according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were English language, diagnosis of melanoma of the scalp, and the presence of the following data: characteristics of the residual defect (width and depth), type of reconstruction, follow-up, and surgical outcome. Results: Six hundred twenty-five records were identified after excluding the duplicates; 48 full-text articles were assessed for eligibility, and 17 records were selected for inclusion. A total of 39 patients were included in the review. The majority of patients (n = 20) underwent skin grafting subsequent to dermal regeneration template positioning. Local flaps (n = 10), free flaps (n = 7), skin grafting alone (n = 1), and dermal regeneration template positioning alone (n = 1) were less frequent. Conclusions: Numerous reconstructive strategies for the scalp are described in the literature. Melanoma patients present a greater variability in terms of general health conditions and social needs that must be taken into account while choosing the most suitable procedure.

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Application of the pinwheel flap for closure of a large defect of the scalp

Cited by 5 publications

References 19 publications

Reconstruction of Scalp Basal Cell Carcinoma UsingPinwheel Flap: A Case Report

Reconstruction of Scalp Basal Cell Carcinoma UsingPinwheel Flap: A Case Report

Use of the O‐Z flap as an alternative to free tissue transfer for reconstruction of large scalp defects

Surgical Reconstruction following Wide Local Excision of Malignant Melanoma of the Scalp

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