Free Flaps in the Treatment of Locally Advanced Malignancy of the Scalp and Forehead

Abstract

Locally advanced cutaneous malignancy of the scalp and forehead is a disease that requires an aggressive approach to resection and reconstruction. Free flap reconstruction in these sites has been advocated because of the advantages of importing large amounts of well-vascularized tissue into a recipient site, which has often been compromised by previous surgery or radiotherapy. A consecutive series of 32 free flap reconstructions in 29 patients with cutaneous malignancy of the scalp and forehead was reviewed. The flap failure rate was 6% (two flaps) and the major complication rate was 10%. Of the surviving flaps, 97% (N = 29) were successful in reconstructing a challenging group of defects. Three patients developed local recurrence of the primary malignancy (mean follow-up, 21 months). The use of a broad repertoire of free tissue transfers in reconstruction of the scalp and forehead defects has allowed effective treatment of locally advanced malignancy of this region. Critical analysis of the results, however, indicates that microsurgical reconstruction is not without morbidity and that there are refinements in the diagnostic and operative steps of management that can maximize the functional and aesthetic results.

Reconstruction of Extensive Scalp Defects With Anterolateral Thigh Flap

“…[6,7] However, it has certain disadvantages that include the requirement of repositioning the patient intraoperatively to harvest the flap, an unnatural appearance of a skin island in the scalp, difficulty in clinical flap monitoring particularly for the muscle-only flaps, a lack of durability in split-thickness grafts, potential complications such as seroma and wound dehiscence in the donor area, and, finally, sacrification of a functional muscle. [8] The serratus anterior flap is another option for scalp reconstruction. The main limitation of this flap is its size.…”

Anterolateral Thigh Flap Reconstruction of Large External Facial Skin Defects: A Follow-Up Study on Functional and Aesthetic Recipient- and Donor-Site Outcome

“…In larger defects with exposed bone or dura, the advantages of free flaps for head and neck reconstruction have been demonstrated in several studies. [1][2][3][4][5] An ideal soft-tissue free flap for head and neck reconstruction should have the following characteristics 6,7 : versatility in design, adequate tissue stock, superior texture, minimal donor-site morbidity, availability of diverse tissue types on one pedicle, potential for reinnervation, large and long pedicle, feasibility of a two-team approach, and consistent anatomy for an easy and safe flap dissection. Except for the latter, the anterolateral thigh flap 8 has been suggested to have all of these qualities, 9 which prompted us to start using this flap for reconstructing large skin defects of the face and forehead after malignant tumor resection.…”

Free latissimus dorsi flap transfer for subtotal scalp and cranium defect reconstruction: Report of 7 cases

“…5,6 The importance of adequate preoperative planning is stressed. Free latissimus dorsi transfer is our preferred option for coverage of subtotal or total scalp defects.…”

“…However, based on personal vascular complications in previous operations at the scalp, we prefer the myocutaneous variation. Inspite of the temporarily unpleasant aspect and the need for secondary operation necessary, we are using a myocutaneous flap with a skin paddle for better postoperative monitoring, 6 lower risk of compression of the vascular pedicle and eventually the possibility to secondarily fill up contour depressions in case were no bone reconstruction is carried out.…”