Reconstruction of Large Defects in the Scalp With Fasciocutaneous Flaps

Abstract

Although recent reports have emphasised free microsurgical transfer for reconstruction of extensive defects in the scalp, in our experience a carefully planned scalp flap is a simpler and safer method than a free transfer. Twenty-one patients with defects as large as 10%-60% of the scalp surface area were reconstructed; the calvarium was resected in five cases and the dura mater in two. In 18 cases the flaps were based on a single pedicle: the superficial temporal artery. In three cases the blood supply of the flaps was based on three major homolateral arteries: the superficial temporal, the posterior auricular, and the occipital. The blood supply of all scalp flaps was based on the interconnected network of the aponeurotic plexus and the pedicles were included into flap in 18 cases. The principles of fasciocutaneous flaps were applied for all 21 scalp flaps. The reconstruction of the skull was delayed in all cases, and the dura was replaced by free autogenous periosteum. The donor area was covered with a skin graft in all cases. In all patients the aesthetic and functional results were considered excellent by them and by us. There were no postoperative complications.

Aesthetic and functional advantages of the anterolateral thigh flap in reconstruction of tumor‐related scalp defects

“…Two patients required dura repair with fascia lata at the skull base. Other simultaneous procedures included nerve grafts to the facial nerve (2), ectropion correction (2), 13 fascia lata as a static sling for the oral commissure in facial palsy (2), and inset of Branmark screws in the orbit (1). 14 …”

“…Free flaps employed for reconstruction included antero-lateral thigh flaps (8), suprafascial radial forearm flap (1), lateral arm flap (1), latissimus dorsi muscle flap (1), and myocutaneous vertical rectus abdominis flap (1). Other procedures included nerve grafts to the facial nerve (2), ectropion correction (2), and fascia lata slings for static procedure in facial palsy (2). There was no pedicle revision and no flap failure.…”

Reconstruction of large acquired scalp defects: ten-year experience

“…The reason is because in the cases of large defects, where periosteum was preserved, reconstructions were mainly performed by skin grafts, by which patients were less satisfied. Satisfaction of patients was evaluated as excellent when we performed reconstructions by local flaps and, accordingly, local flaps are the method of choice for reconstruction of small and medium defects, which is also accepted by most of the studies founded in literature (8,18,19,25,36). We have achieved very good results when we used expanders, local flaps in combination with skin grafts or distant flaps.…”

“…We could close, with local flaps, defects of all depths, and cover avascular structures or allomaterial used for reconstruction of osseous defects. Therefore, local flaps are the gold standard for reconstruction of small and medium scalp defects (18,27,36).…”

Carcinoma basocelular invasivo de cuero cabelludo: Caso clínico

“…Los métodos de expansión tisular son una opción a considerar en defectos de tamaño intermedio 1 . La decisión de la cobertura con el colgajo frontal en isla se hizo en base a su sencillez y a la rapidez de la técnica 10 , en contraste con la técnica microquirúrgica que, si bien hubiese requerido un solo tiempo quirúrgico, probablemente hubiese aumentado la morbilidad. Los resultados estéticos (aunque secundarios en este caso) son, además, equiparables con ambas opciones quirúrgicas.…”