Peterson Andrew M, Rapoport Nicholas A, Sprow Holly N, Kallogjeri Dorina, Rich Jason T
Washington University School of Medicine, Head and Neck Tumor Center at Siteman Cancer Center, St. Louis, Missouri, USA.
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Otolaryngol Head Neck Surg. 2025 Oct;173(4):867-874. doi: 10.1002/ohn.1327. Epub 2025 Jul 3.
Assess the patient demographics, comorbidities, tumor and defect characteristics, and operative variables associated with wound complications of scalp defects reconstructed with local flaps for cutaneous malignancies.
Case-control.
Academic medical center from January 1, 2019, to August 1, 2024.
Cases were defined by the presence of any of the following: infection, necrosis, and/or dehiscence of the surgical site. Controls had no wound complications. Odds ratio and adjusted odds ratio (aOR) with 95% confidence intervals were calculated for the predictors using binomial univariate and multivariable logistic regression.
A total of 110 patients (74% males) underwent scalp reconstruction with local flaps (median [min-max] age: 75 years [26-94]). The most common local flaps used were the snail (n = 49, 45%), double hatchet (n = 25, 23%), and large bilobed transposition flaps (n = 15, 14%). The average mean scalp defect diameter of the cohort was 5.5 cm, ranging from 2.5 to 14.0 cm. Forty-two (38%) patients experienced any wound complications with 13 (12%) major wound complications. Moderate-to-severe comorbidity status (aOR 5.1 [1.9-13.4]) and active smoking status (aOR 8.3 [1.2-57.7]) were independently associated with any wound complications. Variables not associated with wound complications were immunosuppression, type of local flap used, size of defect, preservation of hair, and suture type. There was a significant decrease in complications over time.
Major wound complications are infrequent with local scalp flaps in properly selected patients. Moderate-to-severe comorbidity status and active smoking are significant risk factors for wound complications. Improved outcomes over time suggest a learning curve associated with using local scalp flaps. A novel algorithm for scalp reconstruction of cutaneous malignancies is proposed.
评估接受局部皮瓣修复皮肤恶性肿瘤所致头皮缺损的患者人口统计学特征、合并症、肿瘤及缺损特征，以及与伤口并发症相关的手术变量。
病例对照研究。
2019年1月1日至2024年8月1日期间的学术医疗中心。
病例定义为出现以下任何一种情况：手术部位感染、坏死和/或裂开。对照组无伤口并发症。使用二项式单变量和多变量逻辑回归计算预测因素的比值比和调整比值比（aOR）及其95%置信区间。
共有110例患者（74%为男性）接受了局部皮瓣头皮重建手术（年龄中位数[最小值-最大值]：75岁[26-94岁]）。最常用的局部皮瓣是蜗牛皮瓣（n = 49，45%）、双斧形皮瓣（n = 25，23%）和大型双叶移位皮瓣（n = 15，14%）。该队列中头皮缺损的平均直径为5.5 cm，范围为2.5至14.0 cm。42例（38%）患者出现任何伤口并发症，其中13例（12%）出现严重伤口并发症。中重度合并症状态（aOR 5.1 [1.9-13.4]）和当前吸烟状态（aOR 8.3 [1.2-57.7]）与任何伤口并发症独立相关。与伤口并发症无关的变量包括免疫抑制、使用的局部皮瓣类型、缺损大小、毛发保留情况和缝合类型。随着时间推移，并发症显著减少。
在适当选择的患者中，使用局部头皮皮瓣时严重伤口并发症并不常见。中重度合并症状态和当前吸烟是伤口并发症的重要危险因素。随着时间推移结果改善表明使用局部头皮皮瓣存在学习曲线。提出了一种用于皮肤恶性肿瘤头皮重建的新算法。
