Free Latissimus Dorsi Flap Transfer for Scalp and Cranium Reconstruction

Free tissue transfer for scalp and cranium reconstruction is indicated in large defects with exposed brain tissue, deperiosteal cranial bone, and dura which cannot be reconstructed with local flaps or skin grafts.

Free latissimus dorsi transfer was carried out in six patients with subtotal and total scalp defects ( 4x reconstruction after tumor removal, 1x tissue break down after irradiation, 1x defect reconstruction after high voltage injury). There were 2 male and 4 female patients. The ages ranged from 36 to 72 years. Reconstruction was carried out with a muscle flap (1x) or a myocutaneous flap (5x), in combination with a split–thickness skin mesh (1:1.5) graft, done in a single–stage procedure. In a retrospective clinical study the following criteria were evaluated: 1) flap healing, 2) aesthetic results, and 3) complications.

All flaps healed primarily, and all wounds remained closed without any signs of infection. Complete wound healing was achieved after 4 to 8 weeks, depending on the “take” of the skin grafts. Secondary skin grafting was necessary in 2 patients, revision of the donor site in 1 patient. From an aesthetic point of view, 4 patients complained about the appearance of the retroauricular skin island. After removal of the skin island 6 months after the initial operation, all patients judged the results as good or acceptable.

Free LD transfer is the only option for coverage of subtotal or total scalp defects. Contrary to most authors, these authors' preferred donor vessels are the maxillary artery and the external jugular vein. In order to avoid any vascular compression, they use myocutaneous flaps. The skin island must be removed secondarily.