Zabbia Giovanni, Cammarata Emanuele, Franza Mara, Toia Francesca, Tondini Greta, Graziano Francesca, Iacopino Domenico Gerardo, Cordova Adriana
Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, Catania, Italy.
Microsurgery. 2025 Feb;45(2):e70025. doi: 10.1002/micr.70025.
Scalp reconstruction is a challenging field for plastic surgeons. In case of large or complex defects, microsurgical-free flaps are usually required. Reconstructive failure can result in high morbidity and in some cases be life-threatening. In this article, we present our experience in the reconstruction of complex scalp defects with the use of a vastus lateralis (VL) free flap.
From July 2013 to July 2023, we retrospectively analyzed patients who underwent soft tissue reconstruction of the scalp with a VL-free flap at the authors' institution. The patient's demographic, clinical and surgical characteristics, and postoperative complications were recorded and analyzed.
Thirty patients were included. The mean age was 67.3 years. Seventeen patients were male, while 13 were female. In 56.7% of patients, defects resulted from cancer resection. In four patients, the defect was limited to the soft tissues while a multi-layer defect with bone and/or dura involvement was present in 26 patients. Soft tissue reconstruction was always achieved with a VL-free flap (n = 30). In 28 cases, a skin-grafted muscular flap was used. The most used recipient vessels were the superior thyroid vessels (n = 18). Complications occurred in six patients (20%): two cases of total flap loss and two cases of infection of the cranioplasty materials requiring their removal. In two cases patients died within 48 h. All patients were satisfied with the aesthetic and functional results at 6 months.
In the case of complex scalp defects, the gold standard is reconstruction through microsurgical flaps that provide well-vascularized tissue and allow to cover large defects, reducing the incidence of infections and ensuring good brain protection even without cranioplasty. In our experience, VL-free flap represents a valid option, providing a low donor site morbidity, the possibility of a two-team approach, and a low complication rate.
头皮重建对外科整形医生来说是一个具有挑战性的领域。对于大面积或复杂的缺损，通常需要采用游离显微皮瓣。重建失败可能导致高发病率，在某些情况下甚至危及生命。在本文中，我们介绍了使用股外侧肌（VL）游离皮瓣重建复杂头皮缺损的经验。
2013年7月至2023年7月，我们回顾性分析了在作者所在机构接受VL游离皮瓣进行头皮软组织重建的患者。记录并分析患者的人口统计学、临床和手术特征以及术后并发症。
纳入30例患者。平均年龄为67.3岁。男性17例，女性13例。56.7%的患者缺损是由癌症切除引起的。4例患者的缺损仅限于软组织，26例患者存在包括骨和/或硬脑膜受累的多层缺损。均采用VL游离皮瓣进行软组织重建（n = 30）。28例采用植皮肌皮瓣。最常用的受区血管是甲状腺上血管（n = 18）。6例患者（20%）出现并发症：2例皮瓣完全坏死，2例颅骨成形材料感染需要取出。2例患者在48小时内死亡。所有患者在6个月时对美学和功能结果均满意。
对于复杂的头皮缺损，金标准是通过显微皮瓣进行重建，该方法可提供血运良好的组织，能够覆盖大面积缺损，降低感染发生率，即使在没有颅骨成形术的情况下也能确保良好的脑保护。根据我们的经验，VL游离皮瓣是一种有效的选择，具有供区发病率低、可采用双组手术方式以及并发症发生率低的特点。
