Othman Sammy, Azoury Saïd C, Tecce Michael G, Shakir Sameer, Rios-Diaz Arturo J, Mauch Jaclyn T, Tilahun Estifanos, Broach Robyn B, Kovach Stephen J
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
J Craniofac Surg. 2020 Jun;31(4):1107-1110. doi: 10.1097/SCS.0000000000006421.
Soft-tissue reconstruction of the scalp has traditionally been challenging in oncologic patients. Invasive tumors can compromise the calvarium, necessitating alloplastic cranioplasty. Titanium mesh is the most common alloplastic material, but concerns of compromise of soft-tissue coverage have introduced hesitancy in utilization. The authors aim to identify prognostic factors associated with free-flap failure in the context of underlying titanium mesh in scalp oncology patients.
A retrospective review (2010-2018) was conducted at a single center examining all patients following oncologic scalp resection who underwent titanium mesh cranioplasty with free-flap reconstruction following surgical excision. Patient demographics, comorbidities, ancillary oncological treatment information were collected. Operative data including flap type, post-operative complications including partial and complete flap failure were collected.
A total of 16 patients with 18 concomitant mesh cranioplasty and free-flap reconstructions were identified. The majority of patients were male (68.8%), with an average age of 70.5 years. Free-flap reconstruction included 15 ALT flaps (83.3%), 2 latissimus flaps (11.1%), and one radial forearm flap (5.5%). There were three total flap losses in two patients. Patient demographics and comorbidities were not significant prognostic factors. Additionally, post-operative radiation therapy, ancillary chemotherapy, oncological histology, tumor recurrence, and flap type were not found to be significant. Pre-operative radiotherapy was significantly associated with flap failure (P < 0.05).
Pre-operative radiotherapy may pose a significant risk for free-flap failure in oncologic patients undergoing scalp reconstruction following mesh cranioplasty. Awareness of associated risk factors ensures better pre-operative counseling and success of these reconstructive modalities and timing of pre-adjuvant treatment.
传统上，肿瘤患者的头皮软组织重建具有挑战性。侵袭性肿瘤会累及颅骨，需要进行异体颅骨成形术。钛网是最常用的异体材料，但对软组织覆盖受损的担忧导致其使用存在犹豫。作者旨在确定头皮肿瘤患者在使用钛网的情况下与游离皮瓣失败相关的预后因素。
在单一中心进行回顾性研究（2010 - 2018年），检查所有接受肿瘤性头皮切除术后进行钛网颅骨成形术并在手术切除后进行游离皮瓣重建的患者。收集患者的人口统计学数据、合并症、辅助肿瘤治疗信息。收集手术数据，包括皮瓣类型、术后并发症，包括部分和完全皮瓣失败情况。
共确定了16例患者，伴有18次钛网颅骨成形术和游离皮瓣重建。大多数患者为男性（68.8%），平均年龄70.5岁。游离皮瓣重建包括15例股前外侧皮瓣（83.3%）、2例背阔肌皮瓣（11.1%）和1例桡侧前臂皮瓣（5.5%）。两名患者共出现三次皮瓣全部失败。患者的人口统计学数据和合并症不是显著的预后因素。此外，术后放疗、辅助化疗、肿瘤组织学、肿瘤复发和皮瓣类型均未发现具有显著性。术前放疗与皮瓣失败显著相关（P < 0.05）。
对于接受颅骨成形术后头皮重建的肿瘤患者，术前放疗可能对游离皮瓣失败构成重大风险。了解相关风险因素可确保更好的术前咨询，并提高这些重建方式的成功率以及辅助治疗的时机。
