Reconstruction of large acquired scalp defects: ten-year experience

Stojičić, Milan; Jovanović, Milan B.; Rasulić, Lukas; Vitošević, Filip

doi:10.5137/1019-5149.jtn.17119-16.1

Cited by 5 publications

(12 citation statements)

References 34 publications

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“…Unfortunately, in this group of patients, the achievement of such goals is often impossible and the aim emphasizes obtaining adequate wound closure in these specific conditions. In general, the surgical treatment of scalp defects includes a wide range of procedures, from simple to complex: spontaneous healing-sanatio per secundam intentionem, closure by direct suturing, skin grafts of various thicknesses (partial to full thickness), a combination of dermal substitutes and skin grafts, local random or axial flaps (cutaneous and galeopericranial), regional flaps, use of tissue expanders in order to gain excess tissue or free tissue transfer [2,13]. Before deciding on the best reconstruction method for defects secondary to skin tumors in irradiated patients, localization, size of the tumor, risk of recurrence, depth, as well as underlying structures affected by the secondary defect, should be carefully evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Microvascular or free flaps are often the optimal solution when large defects or chronic infections are present, as well as when neurocranial structures or alloplastic materials are exposed [2,13,19,20]. Free flaps are able to provide adequate covering for implant hardware while also limiting donor site morbidity in an irradiation-impaired scalp skin quality [2,13,31]. The most common recipient blood vessels are the su- Given the aggressive nature of RIMs, one of the biggest challenges aside from RIM management remains defect reconstruction after resection in tinea capitis patients.…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Nikolić Živanović,

Jurišić,

Marinković

et al. 2023

Medicina

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Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients’ characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic bone necrosis (p = 0.001), as well as skin atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors’ experience in managing these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Nikolić Živanović,

Jurišić,

Marinković

et al. 2023

Medicina

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“…Regarding the patients gender and depth of the scalp defect: (55.6%) of the patients were males while (44.4%) were females, all of them Caucasians, (45.19%) with soft tissue defect, (12%) with all soft tissue but intact pericranium, (33%) with all soft tissue and bone defects, and (10 %) with all soft tissue and bone and dura defects (Stojicic et al, 2017).…”

Section: Remote Ports Can Be Internally or Externally Located The Adv...mentioning

confidence: 99%

Evaluation of Local Axial Flaps in Scalp Defects Reconstruction

2022

Al-Azhar Medical Journal

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Background:The scalp consists of specialized tissue composed of dense hair follicles and inelastic thick galea aponeurotica, unlike other tissues of the body. Reconstruction of the scalp can be challenging because of the convexity of the underlying skeleton, the inelasticity of the galea, and the paucity of the adjacent tissue, which make even small defects difficult to close.Objective: To evaluate the local axial flaps used in reconstruction of the different scalp defects in terms of feeding vessels, arc of rotation, and flap dimensions.Patients and Methods: Twenty patients between 5-68 years old who had medium to huge scalp defects caused by burn, trauma and malignancy were subjected to this study at Al-Azhar University Hospitals (Al-Hussein and Al-Sayed Galal) to evaluate the effect of local axial flaps in them in terms of stable coverage of the defects with similar hair-bearing tissue, re-creation of the hairline, matching skin thickness, color and minimal donor site morbidity.Results: Non-expanded rotational and expanded advancement flap were the most used flaps, and the least used was the transposition flap. Minor complications included: seroma happened in 3 patients (25.0%) and graft loss in 2 patients (10%). Distal flap necrosis occurred in 3 patients (15%), TE Exposure in 2 patients (10%), wound dehiscence in 2 patients (10%), and ischemic necrosis of skin over the expander happened in 1 patient (5%). Conclusion:Reconstruction of scalp defects with local flaps is a safe, relatively short and simple procedure unlikely to cause any major complications or demand special postoperative care. In cranial or dural defect, a local scalp flap is the reconstructive method of choice. Application of local axial flaps indicates that complications were quite rare and did not extensively affect the survival of the flaps.

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“…Exposed cranium with subsequent granulation tissue formation was covered successfully by skin graft. [5][6] Among local flaps rotation advancement, transposition, orticochia and bipedicle flaps are the few options. Scalp wound demands early reconstruction if calvarial bone or dura is exposed.…”

Section: Introductionmentioning

confidence: 99%

“…The flap planned by marking two parallel incisions for coverage of defects. The flap designed 1.5 to two times larger than the defect size (fig [1][2][3][4][5][6][7][8]. Before raising the flap infiltration with 20 to 30 ml of 1/1000 adrenaline done.…”

Section: Introductionmentioning

confidence: 99%

Versatility of Bipedicle Flap for Reconstruction of Large Scalp Defects

Sajjad¹,

Afzal²,

Akhlaque

et al. 2020

APMC

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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.

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Reconstruction of large acquired scalp defects: ten-year experience

Cited by 5 publications

References 34 publications

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Reconstruction of Moderately and Severely Atrophic Scalp—A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm

Evaluation of Local Axial Flaps in Scalp Defects Reconstruction

Versatility of Bipedicle Flap for Reconstruction of Large Scalp Defects

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