Scalp reconstructive flaps

Scalp reconstruction requires keen insight into underlying anatomy and surgical armamentarium. The reconstructive surgeon must consider a plethora of complexities to devise a safe and cosmetically maximized outcome. The purpose of this article is to review scalp reconstruction techniques and the current literature in the framework of the reconstructive ladder, with special emphasis on local flap consideration, design, and execution.

Microsurgical Scalp Reconstruction: An Overview of the Contemporary Approach

Background Microsurgical scalp reconstruction has evolved immensely in the last half-century. The core concepts of microsurgical scalp reconstruction have always been to transfer soft tissue of a sufficient quality to within the defect while minimizing donor site morbidity. Refinements in scalp reconstruction consist of both improvement in reducing donor site morbidity and enhancing recipient site contour and balance. Furthermore, technical advancements and the vast experience within our field have allowed for preoperative evaluation of recipient vessels that are more favorable in proximity to the scalp. Methods In this review, we aim to describe the contemporary approach to microsurgical scalp reconstruction. This is to include the indications of choosing free flaps as well as how to select the ideal flap based on patient-oriented factors. The need for cranioplasty, recipient vessel selection, operative technique, and reoperations is also reviewed. In addition, our considerations and the nuances within each category are also described. Summary Scalp reconstructions involve the fundamental tenants of plastic surgery and demand application of these principles to each case on an individual basis and a successful reconstruction must consider all aspects, with backup options at the ready. Two workhorse free flaps, the anterolateral thigh perforator and latissimus dorsi muscles flaps, serve a primary role in the contemporary approach to microsurgical scalp reconstruction. Conclusion We hope this review can lay the foundation for which future plastic surgeons may continue to build and advance the approach to complex microsurgical scalp reconstruction.

Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps

Microsurgical scalp reconstruction is indicated in patients with large scalp defects. The aim of this study was to compare the outcomes of scalp reconstruction in oncologic patients reconstructed with latissimus dorsi (LD), anterolateral thigh (ALT), and omental (OM) free flaps. Thirty oncologic patients underwent scalp reconstruction with LD (10), ALT (11), and OM (9) flaps. The length of the vascular pedicle, the operation time, the possibility of a two-team approach, the length of hospital stays, the complications, and the aesthetic results were evaluated. The OM flap was the flap with the shortest vascular pedicle length with a mean of 6.26 ± 0.16 cm, compared to the LD flap, which was 12.34 ± 0.55 cm and the ALT flap with 13.20 ± 0.26 cm (p < 0.05). The average time of surgery was 6.6 ± 0.14 h in patients reconstructed with OM, compared to the LD flap, which was 8.91 ± 0.32 h and the ALT flap with 7.53 ± 0.22 h (p < 0.05). A two-team approach was performed in all patients for OM flaps and ALT flaps, but only in two patients reconstructed with the LD flap (p < 0.001). In patients reconstructed with the OM flap, a very satisfactory or satisfactory result was reported in seven patients (77.8%). Eight patients reported a very unsatisfactory or unsatisfactory result with LD flap (80%) and 10 patients with ALT flap (90.9%) (p = 0.002). The mean hospital stay after surgery was not statistically significant (p > 0.05). As for complications, two patients reconstructed with OM flap, five LT flaps, and two ALT flaps developed complications, not statistically significant (p = 0.235). Omental flap, latissimus dorsi flap, and anterolateral thigh flap fulfill most of the characteristics for complex scalp reconstruction. The decision on which flap to use should be based on clinical aspects of the patients taking into account that the three flaps show similar rates of complications and length of hospital stay. Regarding the aesthetic outcome, OM flap or LD flap should be considered for reconstruction of extensive scalp defects.

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

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.