From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2021 May 1;147(5):1165-1175. doi: 10.1097/PRS.0000000000007884.
Scalp reconstruction has evolved over time. Given the large surface area, location, and high likelihood of sun exposure, the scalp is particularly prone to sun damage and skin cancer. Resection of scalp cancers often leaves a large defect that can be challenging for reconstruction. The authors present objective data and recommendations based on more than 10 years of consecutive scalp reconstructions performed by the senior author (J.F.T.). In addition, the authors describe each method of reconstruction and delineate an algorithm based on the senior author's approach and the cases assessed.
The authors conducted a retrospective review of patients who underwent scalp reconstruction after Mohs cancer excision over a 10-year period. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications.
The senior author (J.F.T.) performed 913 scalp reconstruction procedures. Defects most commonly involved the forehead or vertex of the scalp, with a wide range of sizes. A significant majority of the patients' defects were repaired with the use of adjacent tissue transfer or Integra dermal regeneration templates. There were 94 complications (12.5 percent) noted, ranging from graft loss to cancer recurrence.
Reconstruction of scalp defects after Mohs cancer excision presents the plastic surgeon with numerous patient and defect preoperative variables to consider. Each defect should be evaluated, and a plan based on composition of the defect and the needs of the patient should be developed. Scalp reconstruction is safe to perform in an outpatient setting, even in elderly patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
头皮重建随着时间的推移而发展。由于头皮面积大、位置特殊且容易暴露在阳光下，因此特别容易受到阳光伤害和皮肤癌的影响。头皮癌切除后常常会留下一个很大的缺陷，这给重建带来了挑战。作者根据高级作者（J.F.T.）进行的 10 多年连续头皮重建提供了客观数据和建议。此外，作者还描述了每种重建方法，并根据高级作者的方法和评估的病例制定了一个算法。
作者对 10 年来接受 Mohs 癌症切除术后头皮重建的患者进行了回顾性研究。对每位患者的关键特征、缺陷位置、缺陷大小、缺陷组成、重建方式和并发症进行了评估。
高级作者（J.F.T.）共进行了 913 例头皮重建手术。缺陷最常见于头皮的额部或顶部，大小范围广泛。绝大多数患者的缺陷都是采用邻近组织转移或 Integra 真皮再生模板修复的。共发现 94 例并发症（12.5%），包括移植物丢失和癌症复发等。
Mohs 癌症切除术后头皮缺陷的重建给整形外科医生带来了许多患者和术前缺陷的变量需要考虑。应评估每个缺陷，并根据缺陷的组成和患者的需求制定治疗计划。头皮重建可在门诊环境下安全进行，即使是老年患者也是如此。
临床问题/证据水平：治疗性，IV 级。
