Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Microsurgery. 2024 Jul;44(5):e31190. doi: 10.1002/micr.31190.
Scalp defect reconstruction poses considerable challenges, with ongoing debates regarding the most effective strategies. While the latissimus dorsi (LD) flap has traditionally been favored, the anterolateral thigh (ALT) flap has been well described as a versatile alternative for addressing extensive scalp defects. This study underscores the success of scalp reconstruction using ALT flaps, notably pushing the boundaries of previously reported flap sizes. Our approach leverages the use of indocyanine green (ICG) perfusion to guide precise preoperative planning and vascular modification, contributing to improved outcomes in challenging cases.
We performed 43 ALT flap reconstructions for scalp defects between 2016 and 2023. We collected patients' demographic and clinical data and evaluated flap size and recipient vessels and additional surgical techniques. Detailed preoperative plans with ultrasound and ICG use for intraoperative plans were performed to find perforators location. The cohort was divided into two, with or without complications on flaps, and analyzed depending on its surgical details.
This study involved 38 patients with extensive scalp defects (mean age: 69.4 ± 11 years) who underwent ALT perforator flap transfers (mean flap size: 230.88 ± 145.6 cm). There was only one case of unsuccessful flap transfer, and four cases had a few complications. The characteristics of the complication group included a large flap size (303.1 ± 170.9 vs. 214.9 ± 136.6 cm, P = .211), few perforator numbers without pedicle manipulation, lack of intraoperative indocyanine green administration (75% vs. 25%, P = .607), and the use of superficial temporal vessels as recipient vessels.
Scalp reconstruction using large ALT free flaps with the aid of imaging modalities facilitates the optimization of surgical techniques, such as pedicle manipulation, perforator numbers, and vein considerations, thereby contributing to successful reconstruction.
头皮缺损的重建极具挑战性，目前对于最有效的策略仍存在争议。虽然传统上倾向于使用背阔肌（Latissimus Dorsi，LD）皮瓣，但股前外侧皮瓣（Anterolateral Thigh，ALT）作为广泛用于处理大面积头皮缺损的一种多功能替代方案已得到很好的描述。本研究强调了使用 ALT 皮瓣进行头皮重建的成功，特别是将之前报告的皮瓣尺寸扩大到了极限。我们的方法利用吲哚菁绿（Indocyanine Green，ICG）灌注来指导精确的术前规划和血管修饰，从而提高了在具有挑战性的病例中的治疗效果。
我们在 2016 年至 2023 年间进行了 43 例头皮缺损的 ALT 皮瓣重建。我们收集了患者的人口统计学和临床数据，并评估了皮瓣的大小、受区血管和其他手术技术。使用超声和 ICG 进行详细的术前计划，以指导术中计划，从而找到穿支的位置。根据其手术细节，我们将患者分为有并发症组和无并发症组。
本研究涉及 38 例广泛头皮缺损的患者（平均年龄：69.4±11 岁），他们接受了 ALT 穿支皮瓣转移（平均皮瓣大小：230.88±145.6cm）。只有 1 例皮瓣转移不成功，4 例有少量并发症。并发症组的特点包括皮瓣较大（303.1±170.9 与 214.9±136.6cm，P=0.211）、穿支数量较少且未进行蒂部处理、术中未使用吲哚菁绿（75%与 25%，P=0.607），以及使用颞浅血管作为受区血管。
借助影像学手段，使用大型 ALT 游离皮瓣进行头皮重建有助于优化手术技术，如蒂部处理、穿支数量和静脉考虑，从而促进成功重建。
