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Abstract
BACKGROUND Limited data exist on outcomes of calvarial reconstruction in cancer patients, including the relative efficacy of various cranioplasty materials, and risk factors for complications. METHODS A retrospective review was performed of cancer patients who underwent calvarial reconstruction over a 12-year period. RESULTS A total of 269 patients underwent 289 calvarial reconstructions. Materials used for cranioplasty included titanium mesh (49.8 percent), methylmethacrylate (16.3 percent), porous polyethylene (4.8 percent), polyetheretherketone (4.5 percent), calcium phosphate cement (3.8 percent), autologous bone grafts (2.1 percent), or a combination of materials (18.3 percent). Perioperative (≤30 days after surgery) complications occurred in 42 cases (14.5 percent), of which 29 (10.0 percent) were at the recipient site, most commonly infection (2.8 percent) and cerebrospinal fluid leak (2.4 percent). Risk factors for perioperative complications included radiation therapy (p = 0.012), prior surgery (p = 0.003), and prior infection (p = 0.014). Late recipient-site complications (>30 days after surgery) occurred in 20 cases (6.9 percent), including infection (3.8 percent) and wound dehiscence (3.1 percent), and for which radiation therapy was identified as a risk factor (p = 0.011). The use of calcium phosphate cement in combination with titanium mesh was associated with a higher long-term complication rate (p < 0.001). Twenty-five cases (8.7 percent) required cranioplasty removal, with infection and dehiscence being risk factors for implant loss (p < 0.001 for both). CONCLUSIONS Alloplastic cranioplasty is effective in cancer patients with calvarial defects. Commonly used materials have similar complication profiles, with the possible exception of calcium phosphate cement, which is associated with a higher rate of complications when combined with titanium mesh and used to reconstruct larger defects. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Lin PY, Miguel R, Chew KY, Kuo YR, Yang JCS. The role of the anterolateral thigh flap in complex defects of the scalp and cranium. Microsurgery 2013; 34:14-9. [DOI: 10.1002/micr.22103] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 02/05/2013] [Accepted: 02/11/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Pao-Yuan Lin
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Ros Miguel
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Khong-Yik Chew
- Department of Plastic; Reconstructive and Aesthetic Surgery; Kandang Kerbau Women's and Children's Hospital; Singapore
| | - Yur-Ren Kuo
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Johnson Chia-Shen Yang
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
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Eskiizmir G, Baker S, Cingi C. Nonmelanoma skin cancer of the head and neck: reconstruction. Facial Plast Surg Clin North Am 2013; 20:493-513. [PMID: 23084301 DOI: 10.1016/j.fsc.2012.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reconstruction of facial defects formed after resection of skin cancers is a challenging procedure. Achieving the best functional and aesthetic outcome depends on accurate preoperative planning. Reconstructive surgeons should perform a detailed analysis of the facial defect based on location, size, and depth and choose the most appropriate technique according to their experiences and patient preferences and expectations. This article reviews the preoperative analysis of facial defects, and the major principles and techniques of facial reconstruction. Discussed are reconstruction of the nose, lip, cheek, forehead, and eyelid, presenting for each technique the goals of the reconstruction, types of flaps and grafts, and surgical technique.
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Affiliation(s)
- Görkem Eskiizmir
- Department of Otolaryngology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Batstone MD, Fox CM, Dingley ME, Cornelius CP. Cosmetic Tattooing of Free Flaps following Head and Neck Reconstruction. Craniomaxillofac Trauma Reconstr 2012; 6:61-4. [PMID: 24436738 DOI: 10.1055/s-0032-1330840] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 03/09/2012] [Indexed: 10/27/2022] Open
Abstract
Free flap reconstruction of the head and neck is a widespread procedure. The aesthetic outcome is frequently compromised by color mismatch between the donor site skin and the complex pigmentation of the face. Various surgical procedures have been described to improve the appearance of external skin paddles. Medical tattooing is commonly used for nipple pigmentation in breast reconstruction and cosmetic procedures such as permanent makeup. This article describes the technique and its application to head and neck reconstruction. Medical tattooing can be used to improve the cosmetic appearance of head and neck free flaps. There is no donor site morbidity and subtle changes in color can be replicated. The article describes the technique of medical tattooing with the use of illustrative cases. Medical tattooing is a viable alternative for improving the appearance of cutaneous skin paddles following head and neck reconstruction with free flaps. Its advantages include no donor site morbidity, availability of an infinite range of colors, no requirement for general anesthesia, and the ability to use multiple colors in the one flap for complex pigmentation requirements. Its disadvantages include the need for specialized skills and equipment and the fading of color over time.
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Affiliation(s)
| | - Carly M Fox
- Maxillofacial Unit, Royal Brisbane Hospital, Herston, Australia
| | - Mary E Dingley
- Diploma Laser Medicine (ACCS), The Cosmetic Medicine Centre, Toowong, Australia
| | - C Peter Cornelius
- OMFS Department Ludwig Maximilians University Munich, Munich, Germany
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55
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Donald PJ, Boggan J, Farwell DG, Enepekides DJ. Skull base surgery for the management of deeply invasive scalp cancer. Skull Base 2012; 21:343-50. [PMID: 22547959 DOI: 10.1055/s-0031-1284216] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Skin cancer involving the scalp is a common malignancy in the "sun belt areas of the United States." Most early lesions are well managed by primary care physicians and dermatologists. Occasionally we encounter basal cell, squamous cell, and rarely Merkel cell carcinomas that have failed local therapy and present with large tumors invading full thickness scalp, calvarium, and even underlying dura. We describe our experience with 52 such tumors and illustrate their resections and reconstruction. For full thickness lesions we generally do a wide field resection of skin and underlying calvarium followed by dural resection. Reconstruction is usually with dural replacement, calvarial reconstruction with titanium mesh, and cutaneous reconstruction with a musculocutaneous free flap or muscular free flap with an overlying skin graft. Complications, survival rates, and recurrence rates will be presented.
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Herrera F, Buntic R, Brooks D, Buncke G, Antony AK. Microvascular approach to scalp replantation and reconstruction: A thirty-six year experience. Microsurgery 2012; 32:591-7. [DOI: 10.1002/micr.22037] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 07/06/2012] [Indexed: 11/08/2022]
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Larrañaga J, Rios A, Franciosi E, Mazzaro E, Figari M. Free flap reconstruction for complex scalp and forehead defects with associated full-thickness calvarial bone resections. Craniomaxillofac Trauma Reconstr 2012; 5:205-12. [PMID: 24294403 DOI: 10.1055/s-0032-1322534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 02/07/2012] [Indexed: 10/28/2022] Open
Abstract
Extensive defects of the scalp and forehead associated with calvarial bone resections demand complex reconstructions. Free flaps offer vascularized tissue of excellent quality and quantity. We report six patients with extensive scalp and forehead defects associated with calvarial bone resections reconstructed with free flaps. Five patients also required a cranioplasty. The flaps used were two anterolateral thigh flaps, one vastus lateralis flap, one myocutaneous latissimus dorsi flap, one latissimus dorsi flap, and one radial forearm flap. All flaps survived with no partial necrosis. There were no donor site complications. One patient presented an exposure of the alloplastic material used for cranioplasty. We strongly recommend the use of free flaps for this kind of reconstruction.
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Affiliation(s)
- Juan Larrañaga
- Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Capital Federal, Argentina
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Huang AT, Tarasidis G, Yelverton JC, Burke A. A novel advancement flap for reconstruction of massive forehead and temple soft-tissue defects. Laryngoscope 2012; 122:1679-84. [PMID: 22753102 DOI: 10.1002/lary.23355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 03/19/2012] [Accepted: 03/23/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the authors' experience with an extended deep-plane cervicofacial (EDPCF) advancement flap, a modification of the deep-plane cervicofacial flap, for reconstruction of large forehead and temple soft-tissue defects. STUDY DESIGN Case series at a tertiary referral medical center. METHODS The charts of 11 consecutive patients who underwent EDPCF flap surgery for reconstruction of forehead and temple skin cancer defects were reviewed for demographics, smoking status, defect size, length of surgery and hospitalization, American Society of Anesthesiologists Physical Status Classification (ASA) grade, and postoperative complications. RESULTS All patients had reconstruction of large forehead and temple defects following either primary resection or Mohs micrographic surgery for skin cancer. No skin grafting was required for secondary defects. The average defect size was 52.2 cm(2) . Patient ages averaged 74 years with a median ASA grade of 3. Thirty-six percent of patients admitted to smoking. Average operative time was 100 minutes, with 82% of patients treated on an outpatient basis. There were no complications of ectropion or facial nerve injury encountered. Partial distal flap necrosis occurred in one patient who admitted to smoking and resolved with conservative management. CONCLUSIONS The EDCPF flap is a robust flap with a dual arterial supply and both rotation and advancement components. It is ideal in frail patients with good soft-tissue laxity and provides an immediate one-stage reconstruction with ideal skin color, texture, and thickness matches for large forehead and temple defects.
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Affiliation(s)
- Andrew Tsao Huang
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
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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; 34:1759-64. [DOI: 10.1002/hed.21999] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2011] [Indexed: 11/10/2022] Open
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Lee YC, Chiu HY, Shieh SJ. The clinical application of anterolateral thigh flap. PLASTIC SURGERY INTERNATIONAL 2011; 2011:127353. [PMID: 22567234 PMCID: PMC3335597 DOI: 10.1155/2011/127353] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/25/2011] [Indexed: 11/29/2022]
Abstract
The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe.
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Affiliation(s)
- Yao-Chou Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Medical College and Hospital, Tainan 70428, Taiwan
| | - Haw-Yen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Medical College and Hospital, Tainan 70428, Taiwan
| | - Shyh-Jou Shieh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Medical College and Hospital, Tainan 70428, Taiwan
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Shonka DC, Potash AE, Jameson MJ, Funk GF. Successful reconstruction of scalp and skull defects: Lessons learned from a large series. Laryngoscope 2011; 121:2305-12. [DOI: 10.1002/lary.22191] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Denewer A, Khater A, Farouk O, Hegazy M, Mosbah M, Hafez M, Shahatto F, Roshdy S, Elnahas W, Kasem M. Can we put a simplified algorithm for reconstruction of large scalp defects following tumor resection? World J Surg Oncol 2011; 9:129. [PMID: 21999171 PMCID: PMC3228776 DOI: 10.1186/1477-7819-9-129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 10/15/2011] [Indexed: 12/26/2022] Open
Abstract
Background Reconstruction of large scalp defects after tumor resection is a challenging problem. We aimed at putting an algorithm for reconstruction of those defects. Methods Forty-two patients with scalp malignancies were enrolled in this study. Tumors were resected to a 1 cm negative margin and defects were reconstructed according to their size and to patient general condition. Results No peri-operative mortality was encountered. Usage of free flaps was superior in cosmoses and function with an acceptable rate of complications. Conclusion for scalp defects wider than100 cm2, the best tool of reconstruction is free flaps. Pedicled distant flaps are reserved if free flaps are not feasible or failed. Split thickness skin grafts are cosmetically inferior and not suitable for recurrent and irradiated tumours and better reserved for patients who cannot tolerate major operations.
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Affiliation(s)
- Adel Denewer
- Department of Surgical Oncology, Oncology Center - Mansoura University, Mansoura, Egypt.
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Aesthetic and oncologic outcome after microsurgical reconstruction of complex scalp and forehead defects after malignant tumor resection: an algorithm for treatment. Plast Reconstr Surg 2011; 128:321-322. [PMID: 21701353 DOI: 10.1097/prs.0b013e31821745d8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khirwadkar H, Thomas C, Fardy M, Hourihan M. Postoperative subdural haematoma and pneumocephalus mimicking TIA. BMJ Case Rep 2011; 2011:bcr.03.2011.3965. [PMID: 22689273 DOI: 10.1136/bcr.03.2011.3965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 86-year-old man presented with left hand numbness and weakness 10 days after a resection of squamous cell carcinoma of the right side of the scalp. A CT head scan identified a right-sided, hypodense subdural collection without midline shift, with associated pneumocephalus. When the images were reviewed on bony settings, minute drill holes were identified penetrating the outer tables as expected, but also the inner table of the calvarium. With this knowledge, the initial clinical diagnosis altered significantly from that of a transient ischaemic attack to a working diagnosis of a subdural haematoma as a complication of the penetrating injury to the cranium, in a patient with an elevated international normalised ratio.
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The Scarless Latissimus Dorsi Flap for Full Muscle Coverage in Device-Based Immediate Breast Reconstruction: An Autologous Alternative to Acellular Dermal Matrix. Plast Reconstr Surg 2011; 128:71-79. [DOI: 10.1097/prs.0b013e318218fcc6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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