Sun Yangbai, Liu Xuesi, Ye Qingrong, Zhu Qinyuan, Wang Chunmeng, Yan Wangjun
Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.
Transl Cancer Res. 2025 Jul 30;14(7):4024-4033. doi: 10.21037/tcr-2024-2223. Epub 2025 Jul 15.
Balancing surgical margins with effective scalp reconstruction remains a contentious issue in scalp tumor resection. This study aimed to define optimal surgical and therapeutic strategies for tumor resection and subsequent reconstruction in this complex anatomical region.
A retrospective study was conducted on 103 patients who underwent resection of malignant scalp tumors and reconstruction with flaps at Fudan University Shanghai Cancer Center. All patients received extended margin surgery followed by secondary treatment. Data collection included patient demographics, surgical details, defect characteristics, flap types, and treatment outcomes. The aesthetic outcome was assessed using a standardized five-point Likert scale, and follow-up data were collected through outpatient visits and telephone interviews until December 2023.
Among the 103 patients, 4 experienced local recurrence, and 10 developed lymph node metastases. Additionally, six patients had postoperative complications. Regarding aesthetic outcomes, one patient was dissatisfied, six were neutral, and the remaining patients were satisfied. Three representative clinical cases are described in detail. This study represents the largest single-center surgical cohort for malignant scalp tumors with complete long-term follow-up reported to date.
This study proposes a novel concept: maximizing the tumor resection margin can effectively reduce local recurrence in patients, surpassing the traditional 2-cm margin. However, this approach does not significantly impact lymph node metastasis. Most patients undergoing scalp reconstruction with flaps achieved satisfactory aesthetic outcomes with minimal complications.
在头皮肿瘤切除术中，平衡手术切缘与有效的头皮重建仍是一个有争议的问题。本研究旨在确定在这个复杂解剖区域进行肿瘤切除及后续重建的最佳手术和治疗策略。
对复旦大学附属肿瘤医院103例行恶性头皮肿瘤切除并皮瓣重建的患者进行回顾性研究。所有患者均接受扩大切缘手术及后续治疗。收集的数据包括患者人口统计学资料、手术细节、缺损特征、皮瓣类型及治疗结果。采用标准化的五点李克特量表评估美学效果，并通过门诊随访和电话访谈收集随访数据，直至2023年12月。
103例患者中，4例出现局部复发，10例发生淋巴结转移。此外，6例患者出现术后并发症。在美学效果方面，1例患者不满意，6例持中立态度，其余患者满意。详细描述了3个具有代表性的临床病例。本研究是迄今为止报道的最大的单中心恶性头皮肿瘤手术队列，且有完整的长期随访。
本研究提出了一个新的概念：最大化肿瘤切除切缘可有效降低患者局部复发率，超过传统的2厘米切缘。然而，这种方法对淋巴结转移没有显著影响。大多数接受皮瓣重建头皮的患者获得了满意的美学效果，并发症最少
