Plastic reconstruction for extensive scalp defects: own observations analysis and literature review
Keywords:scalp defect, plastic surgery, skin graft, local flap, free skin flap, microsurgery, negative pressure wound treatment
The purpose of the study was to conduct a comparative review of literature on modern methods of closing extensive scalp defects. Special attention was paid to the use of a free perforator flap in such reconstructive surgeries. The analysis of our own series of clinical observations was also carried out.
We have described 4 cases of scalp reconstruction. Patients were operated in 2016–2018. Two patients had traumatic scalp damage and two others had primary scalp tumors; the patients were operated in another institution and were only delivered to our clinic due to failure to remove scalp defect. The average patient age was 45.7±1.3. There were 3 women and 1 man. In two cases, the anterolateral thigh (ALT) flap was used; in one case, latissimus dorsi muscle flap; in one case, axillary fasciocutaneous flap. Superficial temporal artery and an accompanying vein were used as recipient vessels in all patients. In all cases, vascular microanastomoses were applied and in 2 cases, negative pressure wound healing devices were used.
In 3 patients, the primary intention ensured wound healing. In 1 patient, a transplanted flap was rejected postoperatively due to dropped systemic hemodynamics, which required reoperation. The average postoperative period was 14.2±1.2 days. In all cases, a satisfactory cosmetic effect was achieved.
Microvascular free flap grafting is the basis for extensive scalp defects treatment. We recommend using the anterolateral thigh flap given the numerous advantages of the method, including reliability, safety, and positive cosmetic effect.
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