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

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.

scholarly journals Tissue expansion in operated cases of transposition flap of scalp for correction of donor site alopecia and patient’s satisfaction

2018 ◽  
Vol 5 (7) ◽  
pp. 2461
Author(s):  
Pradeep Goil ◽  
Abhimanyu Singh ◽  
Hiranmayi Kumari ◽  
Ayush Jain
Keyword(s):  
Donor Site ◽  
Major Complication ◽  
Tissue Expansion ◽  
Transposition Flap ◽  
Tissue Expanders ◽  
Patient’S Satisfaction ◽  
Scalp Defects ◽  
Scalp Defect ◽  
Post Traumatic ◽  
The Mean

Background: Scalp defects managed by local transposition flaps with donor site alopecia are aesthetically not acceptable to patients. Scalp expansion with tissue expanders is needed for proper correction of this deformity.Methods: Authors retrospectively reviewed all cases of post traumatic and post burn scalp defects that were managed initially by local transposition flap and later by scalp expansion by tissue expanders at our institute over a period of 5 years and conducted an outcome survey. Authors’ institutional protocol in such patients and results of the review are presented.Results: Twenty-eight patients were included in the study. Eight patients had post traumatic and 20 cases had post electric burn scalp defect. The mean age of patients was 28.92±8.26 years. Thirty-eight tissue expanders of various sizes (200-600 ml) were used in 28 patients. The mean follow-up time was 9.07±1.92 months. Major complication rate in present study was 2.63%. Results of outcome survey revealed more than 90% patients were satisfied after third surgery.Conclusions: Scalp transposition flap donor site alopecia can be easily corrected by tissue expansion. The complications are not severe and can be managed easily. It should be offered to all such types of patients, as it leads to proper social rehabilitation and satisfaction among these groups of patients.

scholarly journals Reconstruction of a secondary scalp defect using the crane principle and a split-thickness skin graft

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Lu ◽  
Ke-Chung Chang ◽  
Che-Ning Chang ◽  
Dun-Hao Chang
Keyword(s):  
Skin Graft ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Salvage Procedure ◽  
Primary Defect ◽  
Scalp Defects ◽  
Thickness Skin ◽  
Scalp Defect ◽  
Secondary Defect

Abstract Background Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The “crane principle” is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. Case report We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. Conclusions Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.

scholarly journals Reconstruction of scalp with local axial flaps

2020 ◽  
Vol 6 (9) ◽  
pp. 1692
Author(s):  
Saket Srivastava ◽  
Pradeep Gupta
Keyword(s):  
Tissue Expansion ◽  
Free Tissue Transfer ◽  
Healing Time ◽  
Surrounding Tissue ◽  
Surgical Reconstruction ◽  
Local Flaps ◽  
Transposition Flap ◽  
Scalp Reconstruction ◽  
Scalp Defects ◽  
Scalp Defect

<p><strong>Background:</strong> The scalp is a unique part of the human body and various etiological factors, such as tumour extirpation, infection, burns, or trauma, can lead to scalp defects. Primary closure, skin grafting, local flaps, tissue expansion or free tissue transfer are modalities available for scalp reconstruction. In this article, the authors share their institutional experience using various local flaps concerning the size, location, depth of defect and the quality of surrounding tissue.</p><p><strong>Methods:</strong> From September 2017 to January 2020, 54 patients underwent scalp reconstruction with local flaps for a defect size of 5 to 150 cm<sup>2</sup> in the department of plastic surgery, SMS medical college, Jaipur. Patients were identified by age, sex, cause of the scalp defect; the location, size, and depth of the defect; condition of surrounding tissue and the type of reconstruction done.</p><p><strong>Results:</strong> The most common cause of scalp defect was excision of malignant tumour (50%). Thirty patients had a large sized defect (40-90 cm<sup>2</sup>) and 28 patients had 90-150 cm<sup>2</sup> defects. Surgical reconstruction was done using local flaps, transposition flap was the most used in 36 patients (66.7%) followed by rotation advancement flap in 11 patients (20.4%). The recovery was relatively quick. Minor complications happened in 5 patients (9.3%) that were managed conservatively.</p><p><strong>Conclusions</strong>: In the present era of microsurgical reconstruction, local options as axial flaps provide a simpler and safer method of scalp reconstruction. A carefully planned scalp flap gives healthy, robust, hair-bearing tissue coverage and requires a shorter healing time for the patients.</p>

scholarly journals Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm

2019 ◽  
Vol 81 (02) ◽  
pp. 149-157
Author(s):  
Denis Ehrl ◽  
Alexandra Brueggemann ◽  
P. Niclas Broer ◽  
Konstantin Koban ◽  
Riccardo Giunta ◽  
...  
Keyword(s):  
Average Length ◽  
Donor Site ◽  
Tumor Resection ◽  
Donor Site Morbidity ◽  
Muscle Flaps ◽  
Scalp Defects ◽  
Oncologic Patients ◽  
Deep Infiltration ◽  
Malignant Skin ◽  
Aesthetic Results

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.

scholarly journals Reconstructive Indications of Anterolateral Thigh Free Flaps in Head and Neck Reconstruction

2016 ◽  
Vol 9 (1) ◽  
pp. 040-045 ◽  
Author(s):  
Dhiraj Khadakban ◽  
Akshay Kudpaje ◽  
Krishnakumar Thankappan ◽  
Kiran Jayaprasad ◽  
Tejal Gorasia ◽  
...  
Keyword(s):  
Head And Neck ◽  
Success Rate ◽  
Donor Site ◽  
Free Flaps ◽  
Patient Characteristics ◽  
Donor Site Morbidity ◽  
Head And Neck Reconstruction ◽  
Neck Reconstruction ◽  
Scalp Defects ◽  
Anterolateral Thigh

Anterolateral thigh (ALT) free flap is a common flap with multitude of indications. The purpose of this article is to review the reconstructive indications of the flap in head and neck defects. This is a retrospective study of 194 consecutive ALT flaps. Data including patient characteristics (age, sex, comorbidities), disease characteristics (histology, T stage), and flap characteristics (size of the flap, type of closure of ALT donor site) were collected. The outcome in terms of flap success rate, surgical, and donor site morbidity were studied. A total of 194 flaps were performed in 193 patients over a period of 10 years. Mean age of the patients was 55 years (range 16-80 years). Out of the 193 patients, 91 (47.1%) patients had oromandibular defects, 52 (26.9%) had tongue defects, 15 (7.7%) had pharyngeal defects, 17 (8.8%) had skull base defects, 4 (2%) had scalp defects, and 14 (7.2%) had contour defects of the neck. The overall flap success rate was 95.8% (8 total flap loss out of 194). Hypertrophic scar was the commonest donor site problem seen in 20 (10.3%) patients. This study shows the versatility of free ALT flap in head and neck reconstruction. It is a reliable and safe. Donor site morbidity is minimal.

scholarly journals Application of the pinwheel flap for closure of a large defect of the scalp

2019 ◽  
Vol 12 (8) ◽  
pp. e229420
Author(s):  
Ioannis Varnalidis ◽  
Angelos Mantelakis ◽  
Harry Victor Michael Spiers ◽  
Athina N Papadopoulou
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Hair Follicles ◽  
Local Flap ◽  
Stage Iiia ◽  
Good Cosmetic Result ◽  
Large Defect ◽  
Scalp Defect ◽  
Good Cosmetic

A 74-year-old man had a resultant large oval scalp defect of 12×6 cm (72 cm2) following an excision of a stage IIIA melanoma. We decided to cover the defect with the pinwheel flap, with the aim to provide a good cosmetic result, preservation of hair follicles and minimal donor-site morbidity. This local flap has been traditionally used for much smaller defects. Four L-shaped flaps were designed at equal distances on the vertical and horizontal axes of the defect. The L-shaped flap had a length of 1.5 times the half diameter of the defect (4.5 cm). The incision was made through galea aponeurosis and subsequently undermined at least 3 cm to assist flap advancement. Z-plasties increased the rotation of the flap when it was required. This yielded an excellent reconstructive result at 1-year follow-up, demonstrating the usefulness of the pinwheel flap in large defects on the scalp region.

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