Scalp reconstruction: A 10-year experience

Abstract

Background: The scalp is an important functional and aesthetic structure that protects the cranial bone. Due to its inelastic characteristics, soft-tissue defects of the scalp make reconstruction surgery difficult. This study aims to provide an improved scalp reconstruction decision making algorithm for surgeons.

Methods: This study examined patients who underwent scalp reconstruction within the last 10 years. The study evaluated several factors that surgeons use to select a given reconstruction method such as etiology, defect location, size, depth, and complications. An algorithmic approach was then suggested based on an analysis of these factors.

Results: Ninety-four patients were selected in total and 98 cases, including revision surgery, were performed for scalp reconstruction. Scalp reconstruction was performed by primary closure (36.73%), skin graft (27.55%), local flap (17.34%), pedicled regional flap (15.30%), and free flap (3.06%). The ratio of primary closure to more complex procedure on loose scalps (51.11%) was significantly higher than on tight scalps (24.52%) (p= 0.011). The choice of scalp reconstruction method was affected significantly by the defect size (R = 0.479, p< 0.001) and depth (p< 0.001). There were five major complications which were three cases of flap necrosis and two cases of skin necrosis. Hematoma was the most common of the 29 minor complications reported, followed by skin necrosis.

Conclusion: There are multiple factors affecting the choice of scalp reconstruction method. We suggest an algorithm based on 10 years of experience that will help surgeons establish successful surgical management for their patients.

Keywords: Radiotherapy; Reconstructive surgical procedures; Scalp.

Fig. 1.

A 39-year old man with scalp defect caused by radiation therapy. (A) Preoperative clinical photograph. (B) Intraoperative clinical photograph. (C) Postoperative clinical photograph. (D) Dura mater exposure and skull defect were observed. (E) Reconstruction with titanium mesh plate. Reconstruction of skin defect due to radiation therapy after a central neurocytoma operation. The bone defect was reconstructed with a titanium mesh plate. The superficial temporal artery-based regional flap was performed to cover the scalp defect and the donor site was covered with split-thickness skin graft.

Fig. 2.

Latissimus dorsi muscle free flap. (A) Preoperative clinical photograph. (B) Latissimus dorsi muscle free flap and skin graft. (C) Postoperative clinical photograph. Reconstruction of skull deformity after neurosurgery for traumatic epidural hemorrhage caused by a fall. Latissimus dorsi muscle free flap was performed with splitthickness skin graft.

Fig. 3.

Algorithm for reconstruction of scalp defect.