Subscribe to RSS
DOI: 10.1055/s-0032-1329918
A 15-year Experience of Complex Scalp Reconstruction Using Free Tissue Transfer—Analysis of Risk Factors for Complications
Publication History
30 April 2012
18 August 2012
Publication Date:
19 December 2012 (online)
![](https://www.thieme-connect.de/media/jrm/201302/lookinside/thumbnails/10.1055-s-0032-1329918-1.jpg)
Abstract
Purpose Large, complex scalp defects represent a significant reconstructive challenge, thus a variety of free tissue transfer techniques have been employed to optimally provide soft tissue coverage. The aim of this study is to determine factors associated with complications.
Methods A retrospective cohort study was performed on patients undergoing free tissue transfer for scalp defects from 1997 to 2011. Patients were compared with respect to demographics, defect characteristics, intraoperative factors, flap choice, and postoperative complications.
Results Forty-three flaps were performed in 37 patients with a success rate of 97.7%. Multivariate regression demonstrated that defect characteristics (size of defect) and patient-related factors (age and smoking) were associated with wound complications in scalp reconstruction. Outcomes were similar between the latissimus dorsi (LD) and anterolateral thigh (ALT) groups and the immediate cranioplasty patients with respect to all forms of complications
Conclusions We report a 98% success rate using free tissue transfer for complex scalp defects and identify defect size, patient age, and smoking as factors associated with wound complications. Patient comorbidities were associated with major complications. We report equal efficacy in using the ALT and LD, as well as immediate cranioplasty.
Level of Evidence Prognostic/risk, level III
Note
Presented at the 58th Robert H. Ivy Society Meeting in Philadelphia, PA, on March 10, 2012.
Presented at the 91st American Association of Plastic Surgeons in San Francisco, CA, on April 16, 2012.
-
References
- 1 Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg 2005; 116: 54e-72e
- 2 Seitz IA, Gottlieb LJ. Reconstruction of scalp and forehead defects. Clin Plast Surg 2009; 36: 355-377
- 3 Boeckx WD, van der Hulst RR, Nanhekhan LV, De Lorenzi F. The role of free flaps in the treatment of persistent scalp osteomyelitis. Neurosurgery 2006; 59 (1) (Suppl. 01) ONS64-ONS67 , discussion ONS64–ONS67
- 4 Robson MC, Zachary LS, Schmidt DR, Faibisoff B, Hekmatpanah J. Reconstruction of large cranial defects in the presence of heavy radiation damage and infection utilizing tissue transferred by microvascular anastomoses. Plast Reconstr Surg 1989; 83: 438-442
- 5 Shonka Jr DCJ, Potash AE, Jameson MJ, Funk GF. Successful reconstruction of scalp and skull defects: lessons learned from a large series. Laryngoscope 2011; 121: 2305-2312
- 6 Hardesty RA, Jones NF, Swartz WM , et al. Microsurgery for macrodefects: microvascular free-tissue transfer for massive defects of the head and neck. Am J Surg 1987; 154: 399-405
- 7 Ioannides C, Fossion E, McGrouther AD. Reconstruction for large defects of the scalp and cranium. J Craniomaxillofac Surg 1999; 27: 145-152
- 8 Beasley NJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, Neligan PC. Scalp and forehead reconstruction using free revascularized tissue transfer. Arch Facial Plast Surg 2004; 6: 16-20
- 9 van Driel AA, Mureau MA, Goldstein DP , et al. Aesthetic and oncologic outcome after microsurgical reconstruction of complex scalp and forehead defects after malignant tumor resection: an algorithm for treatment. Plast Reconstr Surg 2010; 126: 460-470
- 10 Oh SJ, Lee J, Cha J, Jeon MK, Koh SH, Chung CH. Free-flap reconstruction of the scalp: donor selection and outcome. J Craniofac Surg 2011; 22: 974-977
- 11 Maxwell GP, Stueber K, Hoopes JE. A free latissimus dorsi myocutaneous flap: case report. Plast Reconstr Surg 1978; 62: 462-466
- 12 Barrow DL, Nahai F, Fleischer AS. Use of free latissimus dorsi musculocutaneous flaps in various neurosurgical disorders. J Neurosurg 1983; 58: 252-258
- 13 Furnas H, Lineaweaver WC, Alpert BS, Buncke HJ. Scalp reconstruction by microvascular free tissue transfer. Ann Plast Surg 1990; 24: 431-444
- 14 Calikapan GT, Yildirim S, Aköz T. One-stage reconstruction of large scalp defects: anterolateral thigh flap. Microsurgery 2006; 26: 155-159
- 15 Borah GL, Hidalgo DA, Wey PD. Reconstruction of extensive scalp defects with rectus free flaps. Ann Plast Surg 1995; 34: 281-285 , discussion 285–287
- 16 McLean DH, Buncke Jr HJJ. Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg 1972; 49: 268-274
- 17 Ueda K, Harashina T, Inoue T, Tanaka I, Harada T. Microsurgical scalp and skull reconstruction using a serratus anterior myo-osseous flap. Ann Plast Surg 1993; 31: 10-14
- 18 Schwabegger A, Ninković M, Brenner E, Anderl H. Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention. Ann Plast Surg 1997; 38: 594-597
- 19 Adams Jr WPJ, Lipschitz AH, Ansari M, Kenkel JM, Rohrich RJ. Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg 2004; 53: 6-11
- 20 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37: 149-159
- 21 Nasajpour H, Steele MH. Anterolateral thigh free flap for “head-to-toe” reconstruction. Ann Plast Surg 2011; 66: 530-533
- 22 Amin A, Rifaat M, Civantos F, Weed D, Abu-Sedira M, Bassiouny M. Free anterolateral thigh flap for reconstruction of major craniofacial defects. J Reconstr Microsurg 2006; 22: 97-104
- 23 Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg 1993; 92: 421-428 , discussion 429–430
- 24 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109: 2219-2226 , discussion 2227–2230
- 25 Chang KP, Lai CH, Chang CH, Lin CL, Lai CS, Lin SD. Free flap options for reconstruction of complicated scalp and calvarial defects: report of a series of cases and literature review. Microsurgery 2010; 30: 13-18
- 26 Demirkan F, Chen HC, Wei FC , et al. The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction. Br J Plast Surg 2000; 53: 30-36
- 27 Demirtas Y, Kelahmetoglu O, Cifci M, Tayfur V, Demir A, Guneren E. Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity. Microsurgery 2010; 30: 24-31
- 28 Chao AH, Yu P, Skoracki RJ, Demonte F, Hanasono MM. Microsurgical reconstruction of composite scalp and calvarial defects in patients with cancer: A 10-year experience. Head Neck 2012;
- 29 Afifi A, Djohan RS, Hammert W, Papay FA, Barnett AE, Zins JE. Lessons learned reconstructing complex scalp defects using free flaps and a cranioplasty in one stage. J Craniofac Surg 2010; 21: 1205-1209
- 30 Seitz IA, Adler N, Odessey E, Reid RR, Gottlieb LJ. Latissimus dorsi/rib intercostal perforator myo-osseocutaneous free flap reconstruction in composite defects of the scalp: case series and review of literature. J Reconstr Microsurg 2009; 25: 559-567
- 31 Wang HT, Erdmann D, Olbrich KC, Friedman AH, Levin LS, Zenn MR. Free flap reconstruction of the scalp and calvaria of major neurosurgical resections in cancer patients: lessons learned closing large, difficult wounds of the dura and skull. Plast Reconstr Surg 2007; 119: 865-872
- 32 Newman MI, Hanasono MM, Disa JJ, Cordeiro PG, Mehrara BJ. Scalp reconstruction: a 15-year experience. Ann Plast Surg 2004; 52: 501-506 , discussion 506