Scalp Reconstruction with Novel Unopposing Double Hatchet Flaps- A Case Series

Though there are regional and distant approaches for acquired scalp defect reconstruction, use of local flaps always have the advantage of retaining the topography of scalp. As in treatment of any other defect the choice of a local flap in scalp wound coverage is dictated by the location, size, and depth of the defect and by the availability of adjacent tissue for reconstruction. The versatile and adaptable triangular hatchet flap with a partial skin and subcutaneous bridged pedicle has great versatility. When used singularly or in pair to cover small and medium sized defects, utilising both rotation and advancement components for its movement, has the benefit of maintaining cosmetic appearance. Double hatchet flaps are used commonly in an opposing manner so as to convert a circular wound to a ‘S’ shaped suture line. In the current case series, with a description of four representative cases, authors have presented a modification of this double hatchet flap in unopposing configuration instead of an opposing pattern to cover scalp defects when the type and extent of injury affecting the scalp prevents in heaving flaps at 180 degree to each other. Authors opine that this technique adds into the ever expanding armamentarium of reconstructive surgeon and can be made use of in the aforementioned conditions wherein the standard pattern cannot be employed to cover moderate sized scalp defects.

Download Full-text

Reconstruction of scalp with local axial flaps

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203575 ◽

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

Background: 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.Methods: From September 2017 to January 2020, 54 patients underwent scalp reconstruction with local flaps for a defect size of 5 to 150 cm2 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.Results: The most common cause of scalp defect was excision of malignant tumour (50%). Thirty patients had a large sized defect (40-90 cm2) and 28 patients had 90-150 cm2 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.Conclusions: 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.

Download Full-text

Sternocleidomastoid Myocutaneous Flap for Scalp Reconstruction

Plastic Surgery Case Studies ◽

10.1177/2513826x19828792 ◽

2019 ◽

Vol 5 ◽

pp. 2513826X1982879

Author(s):

Jin Woo Kim ◽

Do Hun Kim

Keyword(s):

Chronic Inflammation ◽

Primary Closure ◽

Myocutaneous Flap ◽

Free Tissue Transfer ◽

Skin Grafting ◽

Pedicled Flap ◽

Scalp Reconstruction ◽

Scalp Defects ◽

Scalp Defect ◽

Defect Area

Scalp defects may occur due to various causes, such as head trauma. For reconstruction of the defect, a primary closure process, skin grafting, or local flap use are the foremost choices when the defect area is not wide. However, repair is difficult when the wound condition further deteriorates due to chronic inflammation. In this condition, free tissue transfer or a pedicled flap is required to restore normal blood supply. The sternocleidomastoid (SCM) flap is conventionally raised as a superiorly or inferiorly based pedicled flap, easily harvested to rectify a nearby scalp defect; additionally, it may either be muscular or myocutaneous. This report describes a case of successful use of the SCM flap for scalp reconstruction, raised as a superiorly based myocutaneous flap.

Download Full-text

SCALP RECONSTRUCTION: EXPERIENCE OF 50 PATIENTS AT TERTIARY LEVEL CENTRE IN INDIA

10.36106/ijsr/2324795 ◽

2021 ◽

pp. 62-65

Author(s):

RK Jain ◽

Nitesh Lamoria

Keyword(s):

Tissue Expansion ◽

Malignant Tumour ◽

The Body ◽

Surgical Reconstruction ◽

Detailed Knowledge ◽

Body Contour ◽

Scalp Reconstruction ◽

Scalp Defects ◽

Aesthetic Appearance ◽

Scalp Defect

NTRODUCTION Scalp possesses unique anatomical & aesthetic features and occupies the most prominent part of the body. Scalp defects are neither easy to look at or to reconstruct. The factors influencing decision making in the repair of scalp defects are their size, depth and location. Various reconstructive options include primary closure, skin grafts, trephination, local tissue aps with or without tissue expansion, regional myocutaneous ap and microvascular free ap. A successful reconstruction surgery must result in less morbidity, good aesthetic appearance, decreased hospitalization time, preserving the hairline without violating the body contour. METHODS Study was conducted in the Department of Plastic and Reconstructive Surgery, SMS Hospital, Jaipur, India. A sample size of 50 patients From September 2019 to march 2021, requiring scalp reconstruction procedures was taken. All the details of the patient that were relevant to the study were collected during the preoperative, intraoperative and postoperative periods and during follow which was later analyzed. RESULTS The most common cause of scalp defect was excision of malignant tumour (40%). Surgical reconstruction using rotational and transposition ap was done in 37 patients (74%).In 5 cases (10%) reconstruction done using free ap. The recovery was relatively quick in all cases. In 2 cases (4%) partial ap necrosis occur which was managed conservatively. CONCLUSION An aesthetically pleasing scalp reconstruction requires a precise preoperative planning with detailed knowledge of scalp anatomy and blood supply. The wide armamentarium of techniques for reconstruction allows the plastic surgeon to give a much pleasing nal result and his creativity on the table added to all these elements together can give a satisfactory result for the patient.

Download Full-text

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

BMC Surgery ◽

10.1186/s12893-021-01056-y ◽

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.

Download Full-text

Scalp Reconstruction Following High Voltage Electric Burn

Bangladesh Journal of Plastic Surgery ◽

10.3329/bdjps.v3i2.18251 ◽

2014 ◽

Vol 3 (2) ◽

pp. 49-52 ◽

Cited By ~ 1

Author(s):

Md Zakir Hossain ◽

Bidhan Sarker ◽

Lutfar Kader Lenin ◽

Ayesha Hanna ◽

Limon Kumar Dhar

Keyword(s):

Plastic Surgery ◽

High Voltage ◽

Skin Grafting ◽

College Hospital ◽

Transposition Flap ◽

Reconstructive Procedures ◽

Rotation Flap ◽

Medical College ◽

Scalp Reconstruction ◽

Scalp Defects

Background: Scalp reconstruction following high voltage electric burn can be challenging. A useful Reconstructive algorithm is lacking. The purpose of this study was to evaluate our experience and to identify an appropriate reconstructive strategy. Methodology: This was a prospective observational study, conducted in the Burn unit of Dhaka Medical College Hospital & Department of Burn & Plastic Surgery,Sir Salimullah Medical College & Mitford Hospital over a period of five years. Reconstructive procedures, independent factors and outcomes were evaluated. A total of 7 procedures were performed in 30 patients. Techniques for reconstruction included skin grafting, outer table drilling & skin grafting, Bipedicle flap, Single rotation flap, Double opposing rotation flap, Transposition flap, Tissue expansion & primary closure. Conclusion: Important tenets for successful management of scalp defects are durable coverage, adequate debridement, preservation of blood supply, and proper wound drainage. Local scalp flaps with skin grafts remain the mainstay of reconstruction in most instances. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18251 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 49-52

Download Full-text

Cryptoccal meningitis in non-HIV, non-organ transplant diabetic patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20211060 ◽

2021 ◽

Vol 8 (4) ◽

pp. 591

Author(s):

Sneha Biradar ◽

Balakrishna Teli

Keyword(s):

Human Immunodeficiency Virus ◽

Organ Transplant ◽

Case Series ◽

Central Nervous System Disease ◽

Diabetic Patients ◽

Immunocompromised Patients ◽

Current Case ◽

Infected People ◽

System Disease ◽

Immunodeficiency Virus

Cryptococcosis is an important opportunistic fungal infection and also cause of death due to central nervous system disease among patients with human immunodeficiency virus worldwide. Most of the cases occur in immunocompromised patients like HIV infected people, people with organ transplants and on immunosuppressants. Nowdays there is increase in cases of cryptoccal meningitis among diabetic patients. Current case series includes cryptococcal meningitis among diabetic patients after ruling out of other immunocompromised states.

Download Full-text

Application and Experience of Various Reconstructive Procedures in Scalp Defects

10.53350/pjmhs211561472 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1472-1474

Author(s):

K. Q. Shaikh ◽

A. Q. Shaikh ◽

Z. H. Tunio ◽

R. A. Jhatiyal ◽

M. K. Mugria ◽

...

Keyword(s):

Malignant Tumour ◽

Cross Sectional ◽

Reconstructive Procedures ◽

Scalp Defects ◽

Scalp Defect ◽

Co Morbidity ◽

Plastic Reconstructive Surgery ◽

History Of ◽

Electric Injury

Aim: To evaluate the outcome of various reconstructive procedures in scalp defects. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Plastic/Reconstructive Surgery & Burns, LUMHS Jamshoro from 1st January 2018 to 31st December 2020. Methodology: Thirty patients of scalp wounds were admitted through outpatient and casualty departments. The patients were diagnosed by pre-operative workup and on clinical parameters were included. The patients unfit for general anaesthesia, patients having associated skin pathology, patients with history of allergic reactions and patients having any poorly controlled systemic co-morbidity like diabetes and hypertension were excluded. Results: Twenty two (73.33%) were males and 8 (26.66%) were females with mean age of 38.98±8.25 years. Scalp defect was due to trauma in46.66%, electric injury 23.33%, benign lesions 16.66%, malignant tumour 3.33%, Infection 3.33%, haemangioma and pigmented nevus 3.33%. Follow up duration was 42.34±7.83 weeks. Conclusion: Primary closure remained the mainstay of our treatments hence proved that simplest reconstruction should be used whenever possible to provide the most functional and aesthetic scalp reconstruction, with the least amount of complexity. Key Words: Scalp, Reconstructive surgical procedure, Graft, Flap

Download Full-text

Ultrasonic Tenotomy and Debridement for Calcific Tendinopathy of the Shoulder: A Pilot Case Series

Journal of Primary Care & Community Health ◽

10.1177/2150132720964665 ◽

2020 ◽

Vol 11 ◽

pp. 215013272096466

Author(s):

Jacob L. Erickson ◽

Andrew R. Jagim

Keyword(s):

Rotator Cuff ◽

Sports Medicine ◽

Treatment Options ◽

Case Series ◽

Invasive Treatment ◽

Effective Treatment Option ◽

Current Case ◽

Calcific Tendinopathy ◽

Pain Scores ◽

Post Procedure

Calcific tendinopathy of the rotator cuff is a common cause of shoulder pain and debility. Minimally invasive treatment options have been employed for management; however, ultrasonic tenotomy has not been previously described for management of calcific tendinopathy of the shoulder. The purpose of the current case series was to provide preliminary evidence in support of a novel treatment modality for calcific tendinopathy of the rotator cuff. This descriptive pilot case series included a total of 8 patients with calcific tendinopathy of the supraspinatus that underwent ultrasound-guided ultrasonic debridement in the sports medicine clinic. All procedures were performed by the same physician (JLE). All patients had confirmation of the diagnosis with MRI and ultrasound imaging. Pain was measured pre-procedure and followed until 3-months post-procedure. Very large, statistically significant, reductions (P < .01) in pain scores were observed at 1 (ES = 1.93), 2 (ES = 1.84) and 3 (ES = 2.20) months post-procedure, respectively. All patients experienced a significant reduction in pain scores, regardless of hardness of the calcium deposit, at 1 month post-procedure with pain scores remaining lower than at baseline at 2 and 3 months post-procedure. No adverse events were noted in any patients. Ultrasonic tenotomy and debridement appears to be a safe and effective treatment option for patients with calcific tendinopathy of the supraspinatus.

Download Full-text

Rapid amelioration of severe manic episodes with right unilateral ultrabrief pulse ECT: a case series of four patients

Australasian Psychiatry ◽

10.1177/1039856216663736 ◽

2016 ◽

Vol 25 (1) ◽

pp. 10-12 ◽

Cited By ~ 4

Author(s):

Alexey Sidorov ◽

Prashanth Mayur

Keyword(s):

Electroconvulsive Therapy ◽

Clinical Global Impression ◽

Treatment Efficacy ◽

Rating Scale ◽

Case Series ◽

Inadequate Response ◽

Young Mania ◽

Dramatic Decrease ◽

Current Case ◽

Significant Clinical Improvement

Objective: The aim of this small case series is to describe four cases of severe mania, where ultrabrief pulse electroconvulsive therapy (ECT) was used as a primary mode of treatment. Methods: A retrospective file review was undertaken of four patients identified as having received ultrabrief pulse ECT for severe mania. The outcome measures for treatment efficacy were the Young Mania Rating Scale (YMRS) and Clinical Global Impression (CGI). Results: All the patients showed significant clinical improvement. A comparison of pre- and post-treatment YMRS and CGI scores showed a dramatic decrease in all four cases. However, one patient was shifted to brief pulse ECT due to inadequate response. Conclusions: Ultrabrief pulse ECT may be an effective treatment in cases of severe mania. Due to the very small number of cases in the current case series, no specific conclusions regarding efficacy may be drawn; however, larger, controlled studies would be indicated.

Download Full-text

A case series: Efficacy of short term EMDR on patients with persistent complex bereavement disorder (PCBD)

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.357 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S360-S361

Author(s):

F.D. Usta ◽

A.B. Yasar ◽

A.E. Abamor ◽

M. Caliskan

Keyword(s):

Sleep Disturbances ◽

Case Series ◽

Traumatic Loss ◽

Degree Relative ◽

Current Case ◽

Prolonged Grief ◽

Persistent Complex Bereavement ◽

Competing Interest ◽

Persistent Complex Bereavement Disorder ◽

Emdr Therapy

Grief is a normal response to loss of someone to whom a bond was formed; however, prolonged grief is considered pathological. Persistent complex bereavement disorder (PCBD) is defined as a persistent longing for the deceased over 12 months. Several treatment ways have been used for traumatic loss including eye movement desensitization and reprocessing (EMDR). In the current case series, effectiveness of EMDR on three PCBD patients will be indicated. Three patients applied to the clinic with similar complaints based on different traumatic backgrounds; commonly, all experienced death of a first-degree relative. Complaints of the patients were over-thinking about the deceased, sleep disturbances, self-blaming, social isolation, avoiding talks about lost relative, and loss of interest in activities. After pre-interviews, they were advised EMDR therapy. One session of EMDR was applied to two of the patients, and two EMDR sessions were conducted on one of them. After the sessions, the patients reported not feeling guilty about the loss anymore, returning their normal routines, feeling better, and showing decreased avoidance. Additionally, the scores of scales (CAPS, BAI, BDI, and IES-R) significantly declined. EMDR therapy can show successful results in a shorter time than other treatment ways used for PCBD treatment [1].Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text