Bas Soysal, Oner Cagatay, Eren Hikmet Ihsan, Hacikerim Karsidag Semra, Yilmaz Adem
Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Department of Plastic, Reconstructive and Aesthetic Surgery, Sirnak State Hospital, Sirnak, Turkey.
Sisli Etfal Hastan Tıp Bul. 2021 Sep 24;55(3):349-358. doi: 10.14744/SEMB.2020.98475. eCollection 2021.
Scalp defects may occur following trauma, radiotherapy, oncologic resection, and recurrent surgeries. The hair-bearing scalp has a dual role, which consists of protecting the calvarium and contributing to aesthetic appearance. While the "reconstructive ladder" approach may be used to close small and medium-sized scalp defects, it is not the case for larger ones involving the calvarium or with a radiation therapy history. The aim of this study is to present cases operated due to complex scalp defects, analyze complications, and discuss the choice of reconstruction.
The study consists of 14 patients who were operated between December 2017 and August 2019 due to a complex scalp defect. Patient were evaluated according to age, gender, etiology, radiation therapy history, defect size and location, reconstruction steps, cranioplasty and duraplasty options, type of free flap, recipient artery, vein graft requirement, and complications.
The mean age of patients, which consists of 11 men and three women, was 56.7 years. The etiology for scalp defects included basosquamous carcinoma, squamous cell carcinoma, giant basal cell carcinoma, atypical meningioma, glioblastoma multiforme, angiosarcoma, and anaplastic oligodendroglioma. The defect involved the full thickness of calvarium in nine cases and pericranium in five cases. Cranioplasties were made with rib graft (=1), bone graft (=1), and titanium mesh (=7). Free flaps used for reconstruction were musculocutaneous latissimus dorsi (LD) (=4), LD muscle (=3), anterolateral thigh (ALT) (=4), musculocutaneous ALT (=1), vastus lateralis muscle (1), and rectus abdominis muscle (=1). Flap loss was not observed. Complications occurred in four of the patients; include a partial graft loss, a wound dehiscence, seroma, and an unsatisfactory esthetic result.
Free tissue transfers rather than local flaps should be opted to reconstruct complex scalp defects, as failure of the latter, could create much greater defects, and worse consequences. There are many options for proper reconstruction, and it is essential to select the appropriate one, taking into account the comorbid conditions of each case.
头皮缺损可能发生于创伤、放疗、肿瘤切除及反复手术后。有毛发的头皮具有双重作用，包括保护颅骨和影响美观。虽然“重建阶梯”方法可用于闭合中小型头皮缺损，但对于涉及颅骨或有放疗史的较大缺损则不适用。本研究的目的是介绍因复杂头皮缺损而接受手术的病例，分析并发症，并讨论重建方式的选择。
本研究包括14例在2017年12月至2019年8月期间因复杂头皮缺损接受手术的患者。根据年龄、性别、病因、放疗史、缺损大小和位置、重建步骤、颅骨成形术和硬脑膜成形术选择、游离皮瓣类型、受区动脉、静脉移植需求及并发症对患者进行评估。
患者平均年龄56.7岁，其中男性11例，女性3例。头皮缺损的病因包括基底鳞状细胞癌、鳞状细胞癌、巨大基底细胞癌、非典型脑膜瘤、多形性胶质母细胞瘤、血管肉瘤和间变性少突胶质细胞瘤。9例缺损累及颅骨全层，5例累及颅骨膜。颅骨成形术采用肋骨移植（=1例）、骨移植（=1例）和钛网（=7例）。用于重建的游离皮瓣有背阔肌肌皮瓣（LD）（=4例）、背阔肌肌瓣（=3例）、股前外侧皮瓣（ALT）（=4例）、股前外侧肌皮瓣（=1例）、股外侧肌瓣（1例）和腹直肌瓣（=1例）。未观察到皮瓣丢失。4例患者出现并发症，包括部分移植失败、伤口裂开、血清肿和美学效果不满意。
对于复杂头皮缺损的重建，应选择游离组织移植而非局部皮瓣，因为后者失败可能造成更大的缺损和更严重的后果。有许多合适的重建选择，考虑到每个病例的合并症选择合适的方案至关重要。
