Scalp reconstruction with locoregional and free flaps - a retrospective cohort study.

IF 1 Q3 SURGERY GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW Pub Date : 2024-09-30 eCollection Date: 2024-01-01 DOI:10.3205/iprs000187
Olimpiu Bota, Franziska Beyer, Johann Klein, Tareq A Juratli, Adrian Dragu, Kevin Bienger
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Abstract

Introduction: Scalp defect reconstruction requires interdisciplinary cooperation to restore soft tissue and osseous defects. While wound closure and form restoration, often a short-term treatment goal, ensures patient survival, the long-term preservation of the head and neck's integrity and aesthetics is crucial for maintaining quality of life. This study aims to compare, quantify, and establish a safe and reproducible approach to various reconstruction options and the postoperative complication profile for individual scalp defect areas.

Materials and methods: We retrospectively evaluated patients who underwent scalp reconstruction at our institution between March 2017 and April 2022. The inclusion criterion was the presence of a soft tissue defect at the cranium level.

Results: We included 31 patients in the study (17 males, 14 females), with an average age of 61 years (range 17-92 years). Eight patients had received radiotherapy in the affected region. The mean defect size was 72.5±116 cm2 (range 20-441 cm2), and an average of 3±2 surgeries had been performed before the plastic surgical treatment was initiated. Eleven patients had only a soft tissue defect, while 20 patients had an associated bone defect. Fifteen of these patients received a cranioplasty. The rotation flap was the most frequently used (n=23), with or without split-thickness skin grafting, followed by the free latissimus dorsi muscle flap with split-thickness skin grafting (n=5), and the free lateral arm flap (n=2). Revision surgeries were necessary in 38.7% of cases due to wound healing disorders (n=9), bleeding (n=2), and cerebrospinal fluid leaks (n=1). Eventually, all wounds were successfully closed.

Conclusion: Complex scalp defects can be closed using local flaps, thereby restoring aesthetics and tissue integrity. Free flaps remain a reliable solution for extensive defects. Moreover, in cases requiring cranioplasty, careful preoperative planning and an uncontaminated wound are essential for successful treatment.

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用局部皮瓣和游离皮瓣重建头皮--一项回顾性队列研究。
介绍:头皮缺损重建需要多学科合作,以修复软组织和骨质缺损。虽然伤口闭合和形态恢复通常是短期治疗目标,可确保患者存活,但长期保持头颈部的完整性和美观对维持生活质量至关重要。本研究旨在比较、量化和确定各种重建方案的安全和可重复方法,以及各个头皮缺损区域的术后并发症情况:我们对 2017 年 3 月至 2022 年 4 月期间在我院接受头皮重建术的患者进行了回顾性评估。纳入标准为颅骨水平存在软组织缺损:我们共纳入了 31 名患者(17 名男性,14 名女性),平均年龄为 61 岁(17-92 岁不等)。八名患者曾在受影响区域接受过放射治疗。平均缺损面积为72.5±116平方厘米(范围20-441平方厘米),在开始整形手术治疗前平均进行过3±2次手术。11 名患者只有软组织缺损,20 名患者伴有骨缺损。其中15名患者接受了颅骨成形术。最常使用的是旋转皮瓣(23例),无论是否进行了分层厚皮移植,其次是游离背阔肌肌皮瓣,并进行了分层厚皮移植(5例),以及游离臂外侧皮瓣(2例)。由于伤口愈合障碍(9例)、出血(2例)和脑脊液漏(1例),38.7%的病例需要进行翻修手术。最终,所有伤口均成功闭合:结论:使用局部皮瓣可缝合复杂的头皮缺损,从而恢复美观和组织完整性。对于大面积缺损,游离皮瓣仍是一种可靠的解决方案。此外,对于需要进行颅骨成形术的病例,仔细的术前规划和无污染的伤口是成功治疗的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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