Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm

Abstract Background An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm2, whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm2. The average length of the pedicle was comparable in ALT- and LDM flaps and longer than in GM flaps. Total flap loss with need for revision surgery and minor donor site morbidity occurred in four and three patients, respectively. Conclusion Microsurgical reconstruction of moderate-to-extensive scalp defects remains a reliable method with overall low risks and satisfactory aesthetic results, while, according to our experience, muscle flaps show the best functional and aesthetic results. However, in cases of central scalp defects and in situations when a long vascular pedicle of the flap is important, the ALT flap seems to be the best solution.

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Article Commentary: Optimizing Aesthetic Results in Skin Grafting

The American Surgeon ◽

10.1177/000313481207800229 ◽

2012 ◽

Vol 78 (2) ◽

pp. 151-154 ◽

Cited By ~ 7

Author(s):

Ron Hazani ◽

Ryan Whitney ◽

Bradon J. Wilhelmi

Keyword(s):

Donor Site ◽

Skin Grafting ◽

Donor Site Morbidity ◽

Secondary Intention ◽

Donor Skin ◽

Aesthetic Results ◽

The Aesthetic ◽

Sheet Graft ◽

Surrounding Skin ◽

Tissue Defects

The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.

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Tracheoplasty Using Titanium Reconstructive Plates with Strap-Muscle Flap

Otolaryngology ◽

10.1177/01945998941113p108 ◽

1994 ◽

Vol 111 (3P1) ◽

pp. 205-210 ◽

Cited By ~ 15

Author(s):

Roy A. Casiano ◽

Michael Patete ◽

Todd Lindquist

Keyword(s):

Donor Site ◽

Muscle Flap ◽

Donor Site Morbidity ◽

Tracheal Wall ◽

Tracheal Lumen ◽

Muscle Flaps ◽

Strap Muscle ◽

Respiratory Problems ◽

Medial Migration ◽

Simple Alternative

The reasons for unsuccessful decannulation after a laryngotracheoplasty may be multifactorial depending on the techniques used. Excessive granulation tissue may develop, necessitating further adjunctive procedures. Cartilaginous grafts may get infected, resorb, or collapse into the tracheal lumen. Bulky regional skin-muscle flaps may dehisce under tension or collapse into the tracheal lumen. Medial migration of the split ends of the anterior cartilaginous tracheal rings ensues with subsequent restenosis. Donor-site morbidity may compound these problems as well. During a 2.5-year period, we have performed laryngotracheoplasty on nine patients with 60% to 100% tracheal stenosis using titanium reconstruction plates. The split anterior tracheal wall is fixed by the plates in its expanded position. A neurovascularized strap-muscle flap is used to reconstruct the anterior tracheal wall. The flap becomes epithelialized with squamous epithelium within 3 weeks. Successful decannulation was possible in seven of the nine (78%) patients with no further respiratory problems. Of these, six required no further procedures. This technique offers a viable simple alternative to other methods of laryngotracheoplasty without the need for donor cartilage grafts or thick bulky Skin-muscle flaps.

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Surgical treatment algorithms for post-burn contractures

Burns & Trauma ◽

10.1186/s41038-017-0074-z ◽

2017 ◽

Vol 5 ◽

Cited By ~ 9

Author(s):

Kenji Hayashida ◽

Sadanori Akita

Keyword(s):

Donor Site ◽

Skin Grafting ◽

Donor Site Morbidity ◽

Flap Surgery ◽

Large Defect ◽

Treatment Algorithms ◽

Free Flap Surgery ◽

Aesthetic Results ◽

Joint Motions ◽

Burn Contractures

Abstract Burn contractures produce restrictions in motion and unacceptable aesthetic results, frequently with persistent wounds. Proper planning and tissue selection are essential to minimize donor site morbidity optimizing outcomes. The principle of burn reconstructive surgery requires that the defects after release should be replaced with donor tissues which have matching texture and color as well as enough pliability. Autologous skin grafting or flap surgeries meet these criteria to replace scar tissues and resurface the subsequent to post-released scar defects. Despite the benefits, the use of flaps is often limited in burn patients for many reasons. If a surgeon intends to release completely and reconstruct in one-stage operation, a large defect may result in large donor site morbidity, necessitating flap surgery including free flap surgery. A lot of different methods and procedures are available for resurfacing the defects, and these are reviewed. In this article, algorithms for the release of burn contractures and reconstructive methods are presented. These treatment algorithms should aid in achieving significant improvement in both joint motions and aesthetic deformities.

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The Deep Circumflex Iliac Artery Perforator Flap for Breast Reconstruction: Un lambeau perforateur de l’artère iliaque circonflexe profonde pour la reconstruction mammaire

Plastic Surgery ◽

10.1177/2292550318800329 ◽

2018 ◽

Vol 26 (4) ◽

pp. 229-237 ◽

Cited By ~ 2

Author(s):

Kate Elzinga ◽

Edward Buchel

Keyword(s):

Breast Reconstruction ◽

Iliac Artery ◽

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

Diep Flap ◽

Deep Circumflex Iliac Artery ◽

Epigastric Artery ◽

Early Results ◽

Aesthetic Results

Autologous breast reconstruction using abdominal-based perforator flaps produces excellent aesthetic results with minimal donor site morbidity. The superficial inferior epigastric artery and deep inferior epigastric perforator (DIEP) flaps reliably perfuse a hemi-abdomen, up to the anterior axillary line. Beyond this line laterally, the flank or “love handle” tissue is primarily perfused by the deep circumflex iliac artery (DCIA) or secondarily by the superficial circumflex iliac artery. The flank tissue is a valuable addition to increase flap size when harvested with a DIEP flap or to provide vascularized tissue when the abdomen has been previously harvested. Harvesting the flank tissue in combination with the anterior abdominal tissue improves the contour of the trunk, accentuates the waist, and minimizes secondary revisions to excise prominent “dogears.” The DCIA flap is a novel technique for breast reconstruction. In this article, we describe our technique, pearls and pitfalls, and early results.

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An island flap based on the anterior branch of the superficial temporal artery for perioral defects

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699144 ◽

2006 ◽

Vol 39 (02) ◽

pp. 136-140

Author(s):

Raveendra Reddy Ganji ◽

V. Bhattacharya ◽

Adil Bashir Sheikh ◽

Goyal Sunish

Keyword(s):

Donor Site ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Donor Site Morbidity ◽

Single Stage ◽

Full Thickness ◽

Local Flaps ◽

Forehead Flap ◽

Anterior Branch ◽

Aesthetic Results

ABSTRACTDefects following excision of lesions in and around theoral commissure extending on either lip are not infrequent. A majority of them are malignant. Various local flaps have been described to correct these defects, but sometimes they may not be feasible. However, the advantage of single-stage reconstruction can still be achieved by using an island forehead flap based on the anterior branch of the superficial temporal artery. This is a versatile flap with a reliable blood supply. It is relatively less popular as it involves time-consuming dissection.Aims: We have modified the island forehead flap based on the anterior branch of the superficial temporal artery by designing the flap on the frontoparietal region based on the terminal course of the anterior branch of the superficial temporal artery. Materials and Methods: This flap was used in five cases of perioral defects involving both the upper and lower lips including the angle of the mouth. Conclusions: Small to moderate dimension full thickness perioral defects can thus be reconstructed effectively with this modified flap in a single stage. The functional and aesthetic results are gratifying with minimal donor site morbidity.

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Primary functional and aesthetic restoration of the fingernail in distal fingertip amputations with the eponychial flap

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413489794 ◽

2013 ◽

Vol 39 (5) ◽

pp. 499-504 ◽

Cited By ~ 5

Author(s):

R. M. Fakin ◽

A. Biraima ◽

H. Klein ◽

P. Giovanoli ◽

M. Calcagni

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Reconstruction Technique ◽

Flap Reconstruction ◽

Growth Disturbance ◽

Nail Deformity ◽

Simultaneous Reconstruction ◽

Aesthetic Results ◽

The Aesthetic

Fingertip injuries often result in fingernail defects. Reconstruction of this structure is important for adequate functional and aesthetic results. This study evaluates the eponychial flap reconstruction technique in 45 fingertip amputations with loss of more than half the fingernail. In 33 cases the procedure was performed in combination with a palmar island flap for pulp reconstruction. Average follow up was 5 months. All eponychial flaps healed uneventfully. In 44 cases, the pulp volume was restored without nail growth disturbance. Five complications (9%) were observed (pain, soft nail, and nail deformity). Only one hook nail deformity required reoperation. All patients were satisfied with the aesthetic and functional outcome. We found eponychial flap fingernail reconstruction effective even for injuries proximal to the lunula and have extended the indication for this technique to very proximal fingernail defects. Eponychial flap reconstruction is a simple, safe, and time-effective technique without donor site morbidity. Simultaneous reconstruction of dorsal and palmar injuries should both be performed primarily resulting in the restoration of a satisfying fingertip.

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Acellular dermal matrix used after large surgical ressection in ameloblastoma with buccal mucosa extension: a case report

Research Society and Development ◽

10.33448/rsd-v10i13.21634 ◽

2021 ◽

Vol 10 (13) ◽

pp. e564101321634

Author(s):

Humberto Jácome-Santos ◽

Fernanda Luiza Araújo de Lima Castro ◽

Renata Gonçalves Resende ◽

Renata de Carvalho Lacerda ◽

Aline Fernanda Cruz ◽

...

Keyword(s):

Oral Cavity ◽

Buccal Mucosa ◽

Inflammatory Diseases ◽

Donor Site ◽

Tumor Resection ◽

Acellular Dermal Matrix ◽

Donor Site Morbidity ◽

Dermal Substitute ◽

Dermal Matrix ◽

Acellular Dermal

Neoplastic, traumatic, and inflammatory diseases of the oral cavity and oropharynx frequently result in significant defects after resection, also, they may present challenge reconstruction. Regional and distant flaps such as skin grafts (SGs) are routinely used to cover mucosal defects arising from large resections, to restore tissue volume and preserve function. However, there are some disadvantages, mainly related to the donor site morbidity, including pain, risk of infection, occasional hypertrophic scar, and additional contracture resulting from a relative lack of dermis. Therefore, acellular dermal membrane (ADM) seems to be an applicable option to avoid those issues, and it has been shown good results for covering tissue defects. Thus, this study reports the first experience of using the double-layer dermal substitute (DLDS) (NeveliaÒ made by Symatese, France) in oral cavity, to cover and repair a buccal defect, immediately after a large resection of ameloblastoma extending to buccal mucosa. After surgical intervention and actually in follow-up, the patient shows good aesthetic and functional status, 24 months postoperatively. Thus, this DLDS seems to be a good resource in primary buccal reconstruction after extensive tumor resection. However, more studies are needed to be performed.

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Donor-Site Morbidity of Free Muscle and Perforator Flaps: Comparison of the Gracilis Muscle Flap and the Anterolateral Thigh Flap

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1602724 ◽

2017 ◽

Vol 33 (07) ◽

pp. 526-532 ◽

Cited By ~ 1

Author(s):

M. Rassner ◽

J. Kiefer ◽

H. Bannasch ◽

G. Stark ◽

S. Eisenhardt ◽

...

Keyword(s):

Lower Extremity ◽

Donor Site ◽

Muscle Flap ◽

Donor Site Morbidity ◽

Gracilis Muscle ◽

Perforator Flaps ◽

Muscle Flaps ◽

Gracilis Muscle Flap ◽

Anterolateral Thigh ◽

Alt Flap

Background Both the gracilis muscle flap and the anterolateral thigh (ALT) flap have been described as successful reconstructive options for defect coverage after trauma or tumor resection. In general, free perforator flaps are considered to generate less donor-site morbidity than muscle flaps. Here, we put this hypothesis to the test. Methods In this study, 193 patients who had undergone free flap reconstruction with either free gracilis muscle flaps (n = 131) or ALT flaps (n = 62) were included. Subjective patient satisfaction with the aesthetic and functional outcome of the donor sites was assessed using a self-report questionnaire as well as the Lower Extremity Functional Scale (LEFS). Results Comparing the donor-site morbidity of free ALT and gracilis flaps, the LEFS revealed no significant differences in functional impairment (p = 0.6447) of the lower extremity. The donor-site scar was significantly longer after ALT flap harvest (mean: 21.16 cm) than after gracilis muscle flap harvest (mean: 14.17 cm; p < 0.0001). Furthermore, donor-site numbness was significantly greater in the ALT group than in the gracilis group (p = 0.0068). Conclusion No significant differences in functional impairment of the lower extremity were reported after gracilis muscle and ALT flap harvest. Regarding scar length and level of numbness of the donor site, the gracilis muscle flap was shown to be superior to the ALT flap.

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First Web-space Reconstruction Using the Second Dorsal Metacarpal Artery Cutaneous Flap: A Reliable Choice for Large Defects

10.21203/rs.3.rs-41245/v1 ◽

2020 ◽

Author(s):

Heng Tian ◽

Wenlai Guo ◽

Qinghe Han ◽

Quanzhe Liu ◽

Lei Zhang ◽

...

Keyword(s):

Index Finger ◽

Average Length ◽

Donor Site ◽

Metacarpophalangeal Joint ◽

Donor Site Morbidity ◽

Flap Transfer ◽

Dorsal Metacarpal Artery ◽

Web Space ◽

Fast Procedure

Abstract Background First web-space defect reconstruction is challenging for reconstructive surgeons. The second dorsal metacarpal artery (SDMA) flap is useful in treating hand and finger defects. However, limited studies have used it for the first web-space defects. This study reports a modified SDMA flap to treat first web-space soft-tissue defects. Methods From April 2012 to October 2018, 8 patients underwent a modified SDMA flap transfer (mean flap size, 2 × 3 cm to 4 × 6 cm). The average length of the pedicle was 2.9 cm. On average, the flap was rotated 84°. In 6 patients, full-thickness skin was grafted at the donor sites. The donor site was primarily closed in two cases. Results All wounds were healed without complications of flap failure or donor area-related morbidity. The average follow-up period was 7.9 months, and these patients were satisfied with the functional recovery and cosmetic appearance of the scar area. At the end of follow-up, the average movement range of the metacarpophalangeal joint of the thumb, index finger, and long finger were 84°, 88°, and 87°, respectively, while those of the contralateral thumb, index finger, and long finger were 87°, 88°, and 85°, respectively. The first web of the injured side spanned an average of 73°; the measurement on the contralateral side was 91°. Conclusions The SDMA flap reconstruction is a simple and fast procedure with a wide resurfacing range for large first web-space defects, low donor-site morbidity, and good functional and esthetic appearance.

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Reconstruction of Post-Electrical Burn Scalp Defect with Exposed Bone: A Case Report

10.31487/j.jscr.2020.02.09 ◽

2020 ◽

pp. 1-3

Author(s):

Rafaela Pais Serras ◽

Maria Manuel Mendes ◽

Pedro Martins ◽

Rafaela Pais Serras ◽

Ruben Coelho

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Transposition Flap ◽

Below The Knee ◽

Scalp Defects ◽

Reconstructive Ladder ◽

Degree Burn ◽

Scalp Defect ◽

Exposed Bone ◽

Electrical Burns

Introduction: Electrical burns are potentially devastating injuries and most often occur at the workplace. Scalp defects following electrical burns are a rare occurrence and usually present as a reconstructive challenge. Case Presentation: Male, 31 years old, suffered a high voltage electrical burn at work that resulted in a scalp defect with exposed bone and a third degree burn in the left leg and foot complicated by a compartment syndrome, which needed an emergent fasciotomy and later an amputation below the knee. The scalp defect was covered by a local transposition flap and a skin graft. At 3 months post-operatively flap survived completely with no necrosis or other complications. A satisfactory cosmesis and preservation of scalp contour were achieved. Conclusion: Reconstructive ladder must be respected in reconstruction of these rare and complex defects. Local transposition flaps, if available, are often an ideal choice for scalp reconstruction in that the adjacent tissue is of similar quality to the original defect tissue with a long-term durability, contour preservation, minimal donor site morbidity and an acceptable cosmesis.

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