1
|
Zhang J, Guo L, Ning H, Pei J, Han D, Liu X, Liu J, Song B. Modified Scalp Replantation for Total Scalp Avulsion: Scalp-Shifting Technique. J Craniofac Surg 2024; 35:1564-1567. [PMID: 38830023 DOI: 10.1097/scs.0000000000010373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/05/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Scalp replantation is the best treatment for scalp avulsion due to its functional and esthetic benefits. Regular scalp replantation requires only unilateral or bilateral superficial temporal vascular anastomosis. However, shear force always damages vessels in severe scalp avulsions. Short, superficial temporal vessels (STVs) make tension-free anastomosis challenging. PURPOSE The objective of this article is to improve the regular scalp replantation technique. When the STVs are short, tension-free anastomosis, and cosmetic symmetry can be achieved without vein grafts or vascular replacement. METHOD This study retrospectively reviewed 18 patients with scalp avulsion, of which 10 underwent scalp-shifting replantation, and 8 underwent regular scalp replantation with direct anastomosis of the STVs. Postoperatively, the authors, assessed whether there was a significant difference in the percentage of scalp survival and in the facial symmetry of patients between the 2 methods. RESULT The percentages of scalp survival and facial symmetry were good after surgeries using both methods, and no significant differences were observed. CONCLUSION The authors use scalp-shifting replantation to create tension-free anastomoses in cases where scalp avulsion injuries have left the superficial temporal arteries too short. This technique ensures facial symmetry, scalp reimplantation survival, and equally excellent results in function and esthetics.
Collapse
Affiliation(s)
- Juan Zhang
- Department of Plastic Surgery, Xijing Hospital
| | - Lei Guo
- Department of Plastic Surgery, Xijing Hospital
| | - Hui Ning
- Department of Foreign Languages, School of Basic Medicine, Fourth Military Medical University, Xi'an
| | | | - Dongmei Han
- Department of Plastic Surgery, Xijing Hospital
| | - Xiaohua Liu
- Department of Plastic Surgery, Xijing Hospital
| | - Jiaxi Liu
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Wuhua, People's Republic of China
| | | |
Collapse
|
2
|
Kim D, Oh S, Jeong WS. Successful replantation of an avulsed frontal scalp through microvascular anastomoses of only one artery and one vein: a case report. Arch Craniofac Surg 2024; 25:95-98. [PMID: 38742337 PMCID: PMC11098762 DOI: 10.7181/acfs.2023.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 06/20/2023] [Indexed: 05/16/2024] Open
Abstract
Scalp avulsion is a devastating injury. The best possible procedure is replantation. Several successful scalp replantations with anastomoses of several vessels in large defects have been reported. In this report, we present a case of replantation of a large scalp avulsion using revascularizing with only one artery and vein. Despite the initial signs of flap congestion, we could predict the survival of the replanted scalp and terminate the procedure after detecting good perfusion and washout with indocyanine green fluorescence imaging. The procedure was successful following the patient's recovery of sensory and sweating functions without complications such as flap necrosis or infection. Several important factors for successful scalp replantation with positive esthetic and functional outcomes were considered.
Collapse
Affiliation(s)
- Dongjin Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Somin Oh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Shik Jeong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
3
|
Krishna D, Khan MM, Dubepuria R, Chaturvedi G, Cheruvu VPR. Reconstruction of Scalp and Forehead Defects: Options and Strategies. Cureus 2023; 15:e41479. [PMID: 37551215 PMCID: PMC10404163 DOI: 10.7759/cureus.41479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
Background Aesthetic reconstruction of scalp and forehead defects with local flaps and minimal donor site morbidity is the primary goal of coverage. While selecting the coverage technique, essential factors such as size, location, and components of a defect, hair-bearing or non-hair-bearing nature of skin, status of the exposed skull, need for radiation, patient condition, availability of local tissue, and the potential for hairline distortion should be kept in mind. Materials and methods This is a retrospective analysis in which 54 patients who underwent soft tissue reconstruction of the scalp and forehead defects were included. The defect size was categorized into four groups: small: <4 cm2, medium: 4-50 cm2, large: 50-200 cm2, and very large: >200 cm2. Reconstruction of all defects was done according to the defect's size, location, and depth. All patients were regularly followed at intervals of two weeks, six weeks, and three months, respectively. The outcome was evaluated in terms of flap survival, flap coverage scale, the requirement of secondary treatment, postoperative complications, and final aesthetic appearance. Results In 54 consecutively treated patients with scalp and forehead defects, the male-to-female ratio was 2:1, and the overall mean age of participants was 34.8 years, ranging from 0.5 to 66 years. The most common etiology of the defect was trauma (16; 29.6%), and the most common location of the defect was combined (16; 29.6%). Rotation flap and primary closure were the most commonly performed procedure, each 12 (22.2%) in number. Out of 12 primary closure cases, two patients developed wound dehiscence because of infection. All cases of skin grafting healed well. All cases of transposition flap with skin grafting at the donor site went uneventful, and the dog ear at the base was revised later. One case of the bipedicle flap in which partial graft loss occurred at the donor area was managed with regrafting. Two cases of single rotation flap, one double rotation flap, and one free latissimus dorsi muscle flap developed distal necrosis. The excellent aesthetic outcome was found in all cases of primary closure and single and double rotation flaps. Conclusions Local flaps have an architecture similar to the recipient site, and low donor site morbidity results in an aesthetically more pleasant outcome. In our experience, scalp defects up to 50 cm2 were covered with the local scalp flaps with primary closure of the donor area. Defects ranging from 50 to 200 cm2 required local scalp flap with skin grafting at the donor area. Free tissue transfers are usually needed when the defect is very large, devoid of the periosteum, or with the calvarial defect.
Collapse
Affiliation(s)
- Deepak Krishna
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Manal M Khan
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Rahul Dubepuria
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Gaurav Chaturvedi
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ved Prakash Rao Cheruvu
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| |
Collapse
|
4
|
Zhou J, Chang S, Deng C, Huang G, Jin W, Chen W, Wei Z. Case report: Microsurgical replantation of heel skin and subcutaneous tissue. Front Surg 2023; 9:815125. [PMID: 36684201 PMCID: PMC9852503 DOI: 10.3389/fsurg.2022.815125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 10/11/2022] [Indexed: 01/08/2023] Open
Abstract
A 36-year-old healthy male patient was presented to the emergency room 3 h after experiencing a laceration to the left foot caused by a porcelain shard. The defect measured 7.5 × 6.0 × 0.8 cm, and the composite amputated tissue consisted of skin and subcutaneous layers. The terminal branch of the lateral calcaneal artery was first anastomosed end-to-end to the corresponding artery in the wound defect. The lateral calcaneal nerve was anastomosed after blood flow was restored. The two lateral veins were anastomosed end-to-end to the corresponding veins in the wound defect. Postoperatively, 1.0 × 1.5 cm area of skin necrosis was present at the distal end of the tissue, which healed smoothly after two weeks of dressing changes. The patient had retained excellent aesthetic and functionality by the 37 month follow up. Although such isolated amputation is relatively rare, microsurgical replantation is, thus, a feasible option in the management of heel amputation.
Collapse
|
5
|
Nonreplantable Total Scalp Avulsion Reconstruction with Acellular Biologic Matrix and Long-Term Outcome. J Craniofac Surg 2022; 33:e445-e446. [PMID: 35610751 DOI: 10.1097/scs.0000000000008556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Total scalp avulsion is a significant injury typically occurring as a result of industrial accidents involving high-speed rotary machines. Although ideal, scalp replantation is uncommon secondary to the nature of the injury and lack of viable microvas-cular anastomosis targets. Therefore, these defects are often reconstructed with microvascular free tissue transfer, with or without skin grafting. We present a unique case of a patient with total scalp avulsion achieving complete, stable skin coverage over partially intact periosteum using only spare parts of the amputated scalp as a temporary full-thickness graft and porcine urinary bladder matrix, thus, avoiding significant donor site morbidity or extensive surgery. At 4 years postoperative, the scalp coverage remains stable.
Collapse
|
6
|
Successful Microsurgical Scalp Replantation Utilizing Loupe Magnification. J Craniofac Surg 2021; 33:e46-e47. [PMID: 34967529 PMCID: PMC8694262 DOI: 10.1097/scs.0000000000007897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Total scalp avulsion is a rare injury that poses a unique reconstructive challenge. Microsurgical replantation is considered the first-line choice; yet anastomotic efforts may be strained to find suitable recipient and target vessels. Concomitant injuries may also delay or hinder operative intervention. These complex scenarios are difficult to navigate and necessitate multidisciplinary input to optimize outcomes. As such, the authors present an illustrative case report of a total scalp avulsion injury that underwent successful microsurgical replantation. This report highlights the novel use of loupe magnification in scalp replantation and reviews technical and clinical nuances that facilitate a favorable reconstruction.
Collapse
|
7
|
Kotamarti VS, Heiman AJ, Camargo L, Ricci JA. Identifying Factors Affecting Outcomes in Scalp Replantation: A Systematic Review of the Literature. J Reconstr Microsurg 2021; 38:56-63. [PMID: 34010964 DOI: 10.1055/s-0041-1729876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Replantation is the ideal treatment in traumatic scalp defects to provide immediate coverage with restoration of hair-bearing skin. However, data are limited to case reports and small case series. Comprehensive analysis of techniques and outcomes is not available. Our aim was to systematically analyze the available literature to better understand management and postoperative outcomes of patients undergoing scalp replantation. METHODS A systematic review of the PubMed, Cochrane, and EBSCO databases was performed in October 2019. Search terms included "replantation," "replant," "revascularized," "revascularization," "avulsion," and "scalp." Only papers reporting microvascular replantation of completely avulsed scalps, including case reports, were included. Review articles, non-English language articles, articles discussing nonreplant coverage, incomplete scalp avulsions, and articles discussing delayed scalp replantation were excluded. Data extracted included demographics, percent of scalp affected, mechanism, operative technique, and postoperative outcomes. Statistical analysis was performed using Mann-Whitney U tests, Kruskal-Wallis, and chi-squared tests. RESULTS From a total of 704 initial results, 61 studies were included for analysis comprising 149 scalps. Complete survival was achieved in 54.7%, partial survival in 38.9%, and failure in 6.7%. Total ischemia time greater than 12 hours was associated with complete replant failure. Arterial anastomoses appeared to protect against complete loss. The number of venous repairs, proportion of venous-to-arterial repairs, use of vein grafts, thromboprophylaxis, or intraoperative complications did not affect outcomes. Patients required significant volumes of blood products, which was associated with partial success. Salvage rate after unplanned return to the operating room was 60.0%. Normal hair growth was achieved in all surviving native scalp tissue. CONCLUSION Scalp replantations, while technically challenging, are the ideal treatment for scalp avulsions. Fortunately, these have high rates of success. And as a focal point of a patient's appearance, this is invaluable in restoration of a sense of normalcy.
Collapse
Affiliation(s)
| | - Adee J Heiman
- Division of Plastic Surgery, Albany Medical Center, Albany, New York
| | - Lauren Camargo
- Division of Plastic Surgery, Albany Medical Center, Albany, New York
| | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Montefiore Medical Center, Bronx, New York
| |
Collapse
|
8
|
Cen H, Jin R, Yu M, Weng T. Clinical decision model for the reconstruction of 175 cases of scalp avulsion/defect. Am J Otolaryngol 2021; 42:102752. [PMID: 33125900 DOI: 10.1016/j.amjoto.2020.102752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE It has been reported widely on various methods of repairing scalp avulsion/defect, including anastomotic vessels for total scalp avulsion and dermal grafts (skin grafting, latissimus dorsi or anterior serratus flap, "visor flap" repair.). The long-term retrospective study, however, with large sample size remains rare; and there is no report on decision-making tree for repairing emergency scalp avulsion/defects under critical conditions. METHODS The decision-making model is provided for surgeons to design the scalp reconstruction based on the retrospective analysis of 175 cases of scalp avulsion/scalp defect. In this 10-year retrospective study, 175 cases of the repair of scalp avulsion and scalp defects in a single center were analyzed. The clinical decision model was generated based on representative cases. RESULTS For patients with scalp avulsion/defects, a comprehensive examination and evaluation on systemic injury and complication should be conducted first for saving lives and reducing trauma effects. To make more reasonable clinical decisions, it is also required to determine the location, size, depth of scalp defect the injury area of cranial periosteum, injury of blood vessel or other adjacent organs, and whether the scalp can be reused. Meanwhile, it is necessary to evaluate whether the patient can tolerate long-term anastomotic vascular surgery according to the vital signs and physical status. CONCLUSION The primary treatment goal is to decrease traumatic effects and save patient's life while repairing and reconstructing scalp avulsions and scalp defects. In addition, it is necessary to comprehensively consider the anatomical, functional and cosmetic characteristics of scalp, surgical equipment, team technical skillsets and patient's own pursuit to optimize a reasonable surgical solution.
Collapse
|
9
|
[Anatomical characteristics of the superficial temporal venous system and implications in microsurgery]. ANN CHIR PLAST ESTH 2020; 66:250-256. [PMID: 32981769 DOI: 10.1016/j.anplas.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The superficial temporal vessels remain underused in microsurgery, the superficial temporal vein (STV) being reported as inconstant. The aim of this study was to precise the anatomical characteristics of the superficial temporal venous system by means of a cadaveric anatomical study and a doppler-ultrasound study on healthy subjects. MATERIALS AND METHODS In order to study the anatomical variations of the STV and its different branches in the temporo-parietal area, 10 hemifaces of bodies donated to science were injected with latex and dissected. A doppler-ultrasound study of the superficial temporal venous system was also performed on 10 healthy subjects in order to assess the median diameter of the STV. RESULTS A common temporo-parietal trunk was found on all the bodies dissected, with a mean number of 1,6 [1-3] venous affluents. The STV preceded systematically the superficial temporal artery (STA) in the pre-auricular area. The arterio-venous relationships were in contrast highly variable above that area. The diameter of the STV presented major interindividual variations, with a median diameter of 1,3mm [0,5-2]. CONCLUSION The superficial temporal vessels can be easily identified in the pre-auricular area. With a mean harvestable length of 6,5cm and a mean diameter of 1,3mm, the parietal branch of the STV presents a caliber sufficient for the realization of the anastomoses.
Collapse
|
10
|
Abstract
Total scalp avulsion is a rare but devastating injury currently without proven reconstructive techniques. While microsurgical anastomosis procedures have advanced and allowed for the replantation of digits and limbs, special anatomical considerations and risk of fatal blood loss add to the difficulty of replanting totally avulsed scalps. The authors present their replantation experience of 4 totally avulsed scalps between 2008 and 2017. Despite meticulous reconstructive techniques with proven success in limb and digit replantation, the first 3 cases failed due to various factors (i.e., thrombosis, venous congestion, reavulsion), and with experience, the fourth case was successful. Since total scalp avulsions are rare injuries, case reports are scarce, with only few publications commenting on failures which hold crucial information for surgeons to avoid pitfalls and optimize techniques. In this article, we highlight our experience with both successful and failed replantation of totally avulsed scalps, and offer recommendations and insight for optimization of this rare procedure.
Collapse
|
11
|
Weitz J, Spaas C, Wolff KD, Meyer B, Shiban E, Ritschl LM. A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach. Front Oncol 2019; 9:1130. [PMID: 31709189 PMCID: PMC6823187 DOI: 10.3389/fonc.2019.01130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Reconstructions of complex scalp after ablative resection or by post-traumatic tissue loss, can present difficulties regarding recipient vessel selection, functional, and aesthetic outcome. The harvesting method for many microvascular free flaps requires a need for changing patients position during surgery and makes a simultaneous interdisciplinary two-team approach complicated, which is a major disadvantage regarding safety and operation time. The ideal flap for scalp reconstruction has yet to be described, although the microvascular latissimus dorsi flap is frequently referred to as the first choice in this context, especially after resection of large defects. The purpose of this study is to compare two different microvascular free flaps for a simultaneous scalp reconstruction in an interdisciplinary two-team approach applying a standardized algorithm. All consecutively operated complex scalp defects after ablative surgery from April 2017 until August 2018 were included in this retrospective study. The indications were divided into neoplasm or wound healing disorder. Two microvascular flaps (latissimus dorsi or parascapular flap) were used to cover the soft tissue component of the resulting defects. Seventeen patients met the inclusion criterion and were treated in an interdisciplinary two-team approach. Skull reconstruction with a CAD/CAM implant was performed in 10 cases of which four were in a secondary stage. Nine patients received a parascapular flap and eight patients were treated with latissimus dorsi flap with split thickness skin graft. Anastomosis was performed with no exception to the temporal vessels. One parascapular flap had venous insufficiency after 1 week followed by flap loss. One latissimus dorsi flap had necrosis of the serratus part of the flap. All other flaps healed uneventful and could be further treated with adjuvant therapy or CAD/CAM calvarial implants. Regarding overall complications, flap related complications, flap loss, and inpatient stay no statistical differences were seen between the diagnosis or type of reconstruction. The parascapular flap seems to be a good alternative for reconstruction of complex tumor defects of the scalp besides the latissimus dorsi flap. Stable long-term results and little donor site morbidity are enabled with good aesthetic outcomes and shorter operation time in an interdisciplinary two-team approach.
Collapse
Affiliation(s)
- Jochen Weitz
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Christophe Spaas
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Ehab Shiban
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,Neurosurgery Department, University Hospital of Augsburg, Augsburg, Germany
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| |
Collapse
|
12
|
Malmande V, Rao N, Biradar A, Bansal A, Dutt C. Scalp replantation in a cervical spine injury patient: Lessons learnt. Indian J Plast Surg 2019; 51:243-246. [PMID: 30505099 PMCID: PMC6219346 DOI: 10.4103/ijps.ijps_206_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Total scalp avulsion injury with cervical spine injury is rare. This article is to describe the technical difficulties and precautions to be taken during anatomical replantation. The patients with cervical spine injury should not be considered as an absolute contraindication for anatomical replant if patients are fit for general anaesthesia. We found that the supratrochlear and supraorbital vessels which are anterior and superficial temporal vessels which are lateral can be used to replant without much technical difficulty. We conclude that anatomical replant is always better keeping in mind the technical limitations of anatomical replant in case of cervical spine injury.
Collapse
Affiliation(s)
- Vithal Malmande
- Department of Plastic Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Naveen Rao
- Department of Plastic Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Amaresh Biradar
- Department of Plastic Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Abhilash Bansal
- Department of Plastic Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Chandrika Dutt
- Department of Plastic Surgery, Apollo Hospitals, Bengaluru, Karnataka, India
| |
Collapse
|
13
|
Sokoya M, Misch E, Vincent A, Wang W, Kadakia S, Ducic Y, Smith J. Free Tissue Reconstruction of the Scalp. Semin Plast Surg 2019; 33:67-71. [PMID: 30863215 DOI: 10.1055/s-0039-1678470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reconstruction of scalp defects can be accomplished by many methods, but larger defects, especially those in which the periosteum is absent or calvarial defects are present, require free tissue transfer. Various methods of scalp reconstruction, as guided by the defect components and size, are presented herein, with a focus on free tissue transfer. Different free flaps for scalp reconstructed are described with a comparison of their advantages and disadvantages. Overall, free tissue transfer for scalp defects provides a reliable, durable, and cosmetically adequate reconstructive option.
Collapse
Affiliation(s)
| | - Emily Misch
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Aurora Vincent
- Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Weitao Wang
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
| | - Sameep Kadakia
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Wright State University, Dayton, Ohio
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jesse Smith
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| |
Collapse
|
14
|
Janik SJ, Paraszti I, Hirtler L, Seemann R, Traxler H, Weninger W, Erovic BM. Design of skin islands for a myocutaneous serratus anterior free flap-An anatomical study and clinical implication for pharyngeal reconstruction after laryngopharyngectomy. Clin Otolaryngol 2018; 44:227-234. [PMID: 30411852 PMCID: PMC7380000 DOI: 10.1111/coa.13257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/11/2018] [Accepted: 11/01/2018] [Indexed: 12/01/2022]
Abstract
Objectives The main purpose of this study was to evaluate flap size and flap design of skin islands in myocutaneous serratus anterior free flaps (SAFFs) in fresh cadavers and to further investigate whether myocutaneous SAFFs are suitable flaps for pharyngeal reconstruction after laryngopharyngectomy. Methods Dissection and injection of methylene blue were performed in 20 hemithoraces of 13 fresh cadavers to evaluate flap size and location of skin islands. Based on these pre‐clinical data, we performed pharyngeal reconstruction with myocutaneous SAFF in five patients after laryngopharyngectomy. Results Perfused skin paddles were found in all specimens with a mean size of perfused skin islands of 85.6 ± 49.8 cm2. Lengths and widths of skin islands ranged from 10‐21 cm and 6‐20.5 cm respectively. Flap size did not significantly differ between males and females (P = 0.998), left compared to right hemithoraces (P = 0.468) and between paired specimens (P = 0.915). All skin islands were found within the upper 29.3%‐51.7% of hemithorax (calculated from axilla to costal arch), and between latissimus dorsi muscle posteriorly and anterior axillary line anteriorly. Accordingly, myocutaneous SAFFs were used for pharyngeal reconstruction after laryngopharyngectomy in five patients with advanced hypopharyngeal carcinomas. Three patients had uneventful courses, while one patient developed immediate intraoperative flap loss and another patient developed partial necrosis of SAFF on postoperative day 7. Conclusion Skin islands of SAFF have reliable blood supply, which allow harvest of large myocutaneous SAFFs that can be used also for pharyngeal reconstruction after laryngopharyngectomy.
Collapse
Affiliation(s)
- Stefan J Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - István Paraszti
- Department of Otorhinolaryngology, University Hospital St. Pölten, St. Pölten, Austria.,Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Seemann
- Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
| | - Hannes Traxler
- Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weninger
- Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Boban M Erovic
- Institute for Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| |
Collapse
|
15
|
Steiner D, Horch RE, Eyüpoglu I, Buchfelder M, Arkudas A, Schmitz M, Ludolph I, Beier JP, Boos AM. Reconstruction of composite defects of the scalp and neurocranium-a treatment algorithm from local flaps to combined AV loop free flap reconstruction. World J Surg Oncol 2018; 16:217. [PMID: 30404625 PMCID: PMC6223072 DOI: 10.1186/s12957-018-1517-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/24/2018] [Indexed: 11/22/2022] Open
Abstract
Background Reconstruction of cranial composite defects, including all layers of the scalp and the neurocranium, poses an interdisciplinary challenge. Especially after multiple previous operations and/or radiation therapy, sufficient reconstruction is often only possible using microsurgical free flap transplantation. The aim of this study was to analyze the therapy of interdisciplinary cases with composite defects including the scalp and neurocranium. Methods From 2009 to 2017, 23 patients with 18 free flaps and 10 pedicled/local flaps were analyzed. First choices for free flaps were muscle flaps followed by fasciocutaneous flaps. Results Except for four patients, a stable coverage could be reached in the first operation. Three of these patients received a local scalp rotation flap in the first operation and needed an additional free flap because the local flap was no longer sufficient for coverage after wound healing deficiency or tumor relapse. The superficial temporal artery or external carotid artery served as recipient vessels. In special cases, venous grafts or an arteriovenous loop (AV loop) were used as extensions for the recipient vessels. Conclusions In summary, an interdisciplinary approach with radical debridement of infected or necrotic tissue and the reconstruction of the dura mater are essential to reach a stable, long-lasting reconstructive result. Based on our experience, free flaps seem to be the first choice for patients after multiple previous operations and/or radiation therapy.
Collapse
Affiliation(s)
- Dominik Steiner
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany.
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany.
| | - Ilker Eyüpoglu
- Department of Neurosurgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Marweh Schmitz
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Justus P Beier
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department of Plastic Surgery, Hand and Burn Surgery, University Hospital RWTH Aachen, RWTH, Aachen, Germany
| | - Anja M Boos
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department of Plastic Surgery, Hand and Burn Surgery, University Hospital RWTH Aachen, RWTH, Aachen, Germany
| |
Collapse
|
16
|
Strategies for Complex Scalp Reconstruction in Patients With Poor Recipient Vessels. J Craniofac Surg 2018; 30:e12-e14. [PMID: 30376503 DOI: 10.1097/scs.0000000000004876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Complex scalp defects with poor recipient vessels represent a challenge for plastic surgeons. In these cases, free flaps are the last resort for solving the problem. The authors present 5 difficult cases with complex large scalp and calvarium defects with unsuitable small recipient vessels for anastomoses. For these cases, the lesser saphenous vein was harvested and used as an interposition graft between the external carotid artery, the jugular vein, and the flap. Latissimus Dorsi, Anterolateral Thigh, and serratus anterior were the flaps used for reconstruction. Cranioplasty was simultaneously performed in 4 cases. The scalp defects varied from 83 to 288 cm. All flaps survived. In 1 case (extended Latissimus Dorsi) there was local infection and wound dehiscence with marginal flap necrosis that required flap readvancement. In conclusion, end-to-end anastomosis to the external carotid artery offers strong outflow through the vein graft and flap. A large vein graft allows good outflow and is more resistant to the pressure of the skin envelope. Anastomosis to large neck vessels (internal or external jugular) facilitates drainage since there is also an aspiration effect due to the venous flow circulation through it.
Collapse
|
17
|
Bettoni J, Pagé G, Salsac AV, Constans JM, Testelin S, Devauchelle B, Balédent O, Dakpé S. Quantitative assessment of the flow distribution in the branches of the external carotid by non-injected flow MRI. Dentomaxillofac Radiol 2018; 47:20180153. [PMID: 29916728 DOI: 10.1259/dmfr.20180153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Owing to the lack of databases of blood flow distributions in the external carotid branches, surgeons currently rely on per-operative imaging and on their experience to choose the recipient vessels for microsurgical facial reconstructions. But, thanks to three-dimensional phase contrast angiography (PCA) and kinematic CINE phase contrast (PC) sequences, MRI technologies have the potential to provide quantitative anatomical and hemodynamic information without injection of contrast agent. Having developed and optimized PC-MRI sequences for the small facial vessels, our objective was to investigate the haemodynamic and blood flow distribution in the external carotid branches. We included 31 healthy volunteers in an MRI prospective study. Two-dimensional CINE PC-MRI sequences (average duration time of 2 min 40 s ± 24 s) were performed in the external carotid collaterals (n = 290). A statistical analysis of the flow measurements showed that, despite large interpersonal variabilities, a general flow distribution pattern was obtained by dividing the vessel flow rates by the external carotid artery one (providing local percentages of the incoming flow). The vessels could then be classified in three haemodynamic groups (p < 0.05 Student's test): "low flow" group (lingual artery-12.5 ± 5% of incoming flow), "intermediate flow" group (superior thyroid artery-16.5 ± 10%, internal maxillary artery-20.5 ± 11%, superficial temporal artery-18.4 ± 6%), "high flow" group (facial artery -26.6 ± 10%). Thanks to this general flow distribution mapping, it is now possible to estimate the flow rates in the distal branches of any individual from a single blood flow measurement in the external carotid artery.
Collapse
Affiliation(s)
- Jérémie Bettoni
- 1 Maxillo-facial Surgery Department, Centre Hospitalo-Universitaire d'Amiens Avenue Laennec , Amiens , France.,2 BiFloImage Laboratory, Université de Picardie Jules Verne Avenue Laennec , Amiens , France.,3 Facing Faces Institute Avenue Laennec , Amiens , France.,4 EA CHIMERE, Université de Picardie Jules Verne Avenue Laennec , Amiens , France
| | - Gwénaël Pagé
- 2 BiFloImage Laboratory, Université de Picardie Jules Verne Avenue Laennec , Amiens , France.,3 Facing Faces Institute Avenue Laennec , Amiens , France.,4 EA CHIMERE, Université de Picardie Jules Verne Avenue Laennec , Amiens , France
| | - Anne-Virginie Salsac
- 5 Biomechanics & Bioengineering Laboratory, Université de technologie de Compiègne-CNRS, Sorbonne Universités , Compiègne , France
| | - Jean-Marc Constans
- 3 Facing Faces Institute Avenue Laennec , Amiens , France.,4 EA CHIMERE, Université de Picardie Jules Verne Avenue Laennec , Amiens , France.,6 Radiology Department, Centre Hospitalo-Universitaire d'Amiens Avenue Laennec , Amiens , France
| | - Sylvie Testelin
- 1 Maxillo-facial Surgery Department, Centre Hospitalo-Universitaire d'Amiens Avenue Laennec , Amiens , France.,3 Facing Faces Institute Avenue Laennec , Amiens , France.,4 EA CHIMERE, Université de Picardie Jules Verne Avenue Laennec , Amiens , France
| | - Bernard Devauchelle
- 1 Maxillo-facial Surgery Department, Centre Hospitalo-Universitaire d'Amiens Avenue Laennec , Amiens , France.,3 Facing Faces Institute Avenue Laennec , Amiens , France.,4 EA CHIMERE, Université de Picardie Jules Verne Avenue Laennec , Amiens , France
| | - Olivier Balédent
- 2 BiFloImage Laboratory, Université de Picardie Jules Verne Avenue Laennec , Amiens , France.,3 Facing Faces Institute Avenue Laennec , Amiens , France.,4 EA CHIMERE, Université de Picardie Jules Verne Avenue Laennec , Amiens , France
| | - Stéphanie Dakpé
- 1 Maxillo-facial Surgery Department, Centre Hospitalo-Universitaire d'Amiens Avenue Laennec , Amiens , France.,3 Facing Faces Institute Avenue Laennec , Amiens , France.,4 EA CHIMERE, Université de Picardie Jules Verne Avenue Laennec , Amiens , France
| |
Collapse
|
18
|
Abstract
Successful total scalp replantation was performed in our case. Based on the angiosome concept and anatomical study, the avulsed scalp survived with unilateral anastomosis of the superficial temporal artery and superficial temporal vein, largely due to the presence of rich arterial and venous arcades in the scalp. The patient currently has no problems with activities of daily living, although total hypoaesthesia and dysfunction of the left frontal muscle of the forehead are present. In addition, the combined findings of hair growth pattern indicated the vascular territories of the scalp skin.
Collapse
Affiliation(s)
- Jun Karibe
- Department of Plastic Surgery, Yamanashi Daigaku Igakubu, Chuo, Yamanashi, Japan
| | - Toshiharu Minabe
- Department of Plastic Surgery, Saitama Ika Daigaku Sogo Iryo Center, Kawagoe, Saitama, Japan
| |
Collapse
|
19
|
Ng ZY, Eberlin KR, Lin T, Masiakos PT, Cetrulo CL. Reconstruction of Pediatric Scalp Avulsion Injuries After Dog Bites. J Craniofac Surg 2017; 28:1282-1285. [DOI: 10.1097/scs.0000000000003607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
20
|
Steiner D, Hubertus A, Arkudas A, Taeger CD, Ludolph I, Boos AM, Schmitz M, Horch RE, Beier JP. Scalp reconstruction: A 10-year retrospective study. J Craniomaxillofac Surg 2016; 45:319-324. [PMID: 28043755 DOI: 10.1016/j.jcms.2016.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/14/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022] Open
Abstract
Scalp reconstruction is a challenging task for the reconstructive surgeon. In consideration of the anatomical and cosmetic characteristics, the defect depth and size, an armamentarium of reconstructive procedures ranging from skin grafts over local flaps to free tissue transfer has been described. In this 10-year retrospective study, 85 operative procedures for scalp reconstruction were performed at our department. The underlying entity, defect size/depth, reconstructive procedure, complications, and mean hospital stay were analyzed. In most cases, scalp reconstruction was necessary after oncologic resection (67%) or radiation therapy (16%). A total of 85 operative procedures were performed for scalp reconstruction including local flaps (n = 50), free tissue transfer (n = 18), and skin grafts (n = 17). Regarding the complication rate, we could detect an overall major complication rate of 16.5% with one free flap loss. Briefly, local flaps are an adequate and safe procedure for limited scalp defects. In the case of extensive scalp defects affecting the calvarium, prior multiple surgical interventions and/or radiation, we prefer free tissue transfer.
Collapse
Affiliation(s)
- D Steiner
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Hubertus
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Arkudas
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C D Taeger
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - I Ludolph
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A M Boos
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Schmitz
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - R E Horch
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - J P Beier
- Department of Plastic and Hand Surgery (Head: Univ. Prof. Dr. med. Dr. h.c. R. E. Horch), University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.
| |
Collapse
|
21
|
Khan MN, Rodriguez LG, Pool CD, Laitman B, Hernandez C, Erovic BM, Teng MS, Genden EM, Miles BA. The versatility of the serratus anterior free flap in head and neck reconstruction. Laryngoscope 2016; 127:568-573. [DOI: 10.1002/lary.26116] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/01/2016] [Accepted: 05/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Mohemmed N. Khan
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | | | - Christopher D. Pool
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Benjamin Laitman
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Christopher Hernandez
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
- Department of Otorhinolaryngology; University of Vienna; Vienna Austria
| | | | - Marita S. Teng
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Eric M. Genden
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Brett A. Miles
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| |
Collapse
|
22
|
|
23
|
Simunovic F, Eisenhardt SU, Penna V, Thiele JR, Stark GB, Bannasch H. Microsurgical reconstruction of oncological scalp defects in the elderly. J Plast Reconstr Aesthet Surg 2016; 69:912-9. [PMID: 27133193 DOI: 10.1016/j.bjps.2016.03.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/04/2016] [Accepted: 03/19/2016] [Indexed: 11/24/2022]
Abstract
The incidence of scalp tumors requiring radical excision increases with age. Free flap surgery is the standard reconstructive option for large defects; however, there is an ongoing uncertainty about its safety in the elderly. We conducted a review of data and report on 19 patients aged ≥75 years and 13 < 75 years. Data regarding patient demographics, types of tumors, surgery, size of defect, flaps used, and prevalence of complications were analyzed. The patients in the elderly group had more accompanying medical conditions and a higher ASA score. Squamous cell carcinoma was the predominant tumor in the elderly and sarcoma in the younger patients. The defect size was similar in both groups. The latissimus dorsi (LD) and the anterolateral thigh (ALT) flaps were flaps of first choice, with temporal vessels most commonly used for anastomosis. Surgery lasted longer in the younger patients. There was no difference in the duration of hospital stay. No significant correlation was found between age and the flap-related or medical complications. Revision surgery was more often required in the younger patients. We conclude that free flap surgery is safe and reliable in the elderly population. The LD and the ALT are the most commonly used flaps. Advanced age should not be considered a risk factor for free flap surgery in these patients.
Collapse
Affiliation(s)
- Filip Simunovic
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - Vincenzo Penna
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - Jan R Thiele
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - G Björn Stark
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - Holger Bannasch
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| |
Collapse
|
24
|
Incidence and Features of Vertebral Fractures After Scalp Avulsion Injuries. J Craniofac Surg 2015; 26:2217-20. [DOI: 10.1097/scs.0000000000002121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
25
|
|
26
|
Sosin M, Chaudhry A, De La Cruz C, Bojovic B, Manson PN, Rodriguez ED. Lessons Learned in Scalp Reconstruction and Tailoring Free Tissue Transfer in the Elderly: A Case Series and Literature Review. Craniomaxillofac Trauma Reconstr 2014; 8:179-89. [PMID: 26269725 DOI: 10.1055/s-0034-1393725] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/12/2014] [Indexed: 10/24/2022] Open
Abstract
This article aims to demonstrate an individualized approach to an elderly patient requiring scalp reconstruction, to describe the methodology in flap selection, lessons learned, and report outcomes. A retrospective review of a single surgeon's experience of scalp reconstruction (E. D. R.) using free tissue transfer from 2005 to 2011, in patients older than 70 years, was completed. A total of eight patients met the inclusion criteria, five males and three females, with a mean age of 80.4 years (range, 73-92). Free tissue transfer achieved 100% soft tissue coverage. Six of the eight patients required cranioplasty. The mean size calvarial defect was 92 cm(2) (range, 35-285 cm(2)). The mean flap size was 117.6 cm(2) (range, 42-285 cm(2)). Free flaps included three ulnar, three anterolateral thigh, one latissimus dorsi, and one thoracodorsal perforator flap. The mean follow-up time was 18.4 months (range, 3-46 months). Donor site morbidity was minimal. Mortality was 0%. Immediate flap failure was 0%. Other complications occurred in six of the eight patients. Mean revisionary procedures were 1.25 procedures per patient. It was concluded that chronological age does not increase mortality or catastrophic flap complications; however, morbidity is increased in the elderly and revisionary surgery is likely.
Collapse
Affiliation(s)
- Michael Sosin
- Division of Plastic, Reconstructive, and Maxillofacial Surgery, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Arif Chaudhry
- Division of Plastic, Reconstructive, and Maxillofacial Surgery, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Carla De La Cruz
- Division of Plastic, Reconstructive, and Maxillofacial Surgery, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Branko Bojovic
- Division of Plastic, Reconstructive, and Maxillofacial Surgery, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Paul N Manson
- Department of Plastic Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Eduardo D Rodriguez
- Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York
| |
Collapse
|
27
|
Longo B, Laporta R, Pagnoni M, Campanale A, Grippaudo FR, Santanelli Di Pompeo F. Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face. Microsurgery 2014; 35:177-82. [DOI: 10.1002/micr.22305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Benedetto Longo
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
| | - Rosaria Laporta
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
| | - Marco Pagnoni
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
| | - Antonella Campanale
- Italian Ministry of Health, Directorate General for Medical Devices, Pharmaceutical Services and Safety in Health CareRome Italy
| | - Francesca Romana Grippaudo
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
| | - Fabio Santanelli Di Pompeo
- Plastic Surgery Unit, NESMOS Department, Sant'Andrea Hospital, School of Medicine and Psychology“Sapienza” University of Rome Italy
| |
Collapse
|
28
|
Lee N, Daley RA, Cooley BC. Rat posterior facial vein interpositional graft: A more relevant training model. Microsurgery 2014; 34:653-6. [DOI: 10.1002/micr.22278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/29/2014] [Accepted: 05/02/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Nicolas Lee
- Department of Orthopaedic Surgery; Medical College of Wisconsin; Milwaukee WI
| | - Roger A. Daley
- Department of Orthopaedic Surgery; Medical College of Wisconsin; Milwaukee WI
| | - Brian C. Cooley
- Department of Orthopaedic Surgery; Medical College of Wisconsin; Milwaukee WI
| |
Collapse
|
29
|
Iglesias M, Butrón P, León-López DA, García-Mancilla S, Espino-Gaucin I, Rubio A. Soft tissue reconstruction with omental free flap in complex upper extremity injuries: Report of 13 cases. Microsurgery 2014; 34:425-33. [DOI: 10.1002/micr.22236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 01/16/2014] [Accepted: 01/24/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Martin Iglesias
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Patricia Butrón
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Daniela Alejandra León-López
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Sofía García-Mancilla
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Israel Espino-Gaucin
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Alethia Rubio
- Plastic Surgery Service; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| |
Collapse
|
30
|
Sittitavornwong S, Morlandt ABP. Reconstruction of the scalp, calvarium, and frontal sinus. Oral Maxillofac Surg Clin North Am 2013; 25:105-29. [PMID: 23642666 DOI: 10.1016/j.coms.2013.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Scalp and cranial deformities are common after trauma or ablative surgery. Local flaps and free flaps may be used in reconstruction of soft tissue defects, and autogenous bone or alloplastic bone substitutes may be used for cranioplasty procedures. Injuries to the frontal sinus, particularly when complicated by leak of cerebrospinal fluid or obstruction of the nasofrontal outflow tract, represent special challenges. Further studies are recommended to improve the multidisciplinary management of these complex, debilitating conditions, in anticipation of enhanced function and cosmesis, reduced donor site morbidity, and improved surgical outcomes.
Collapse
|
31
|
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
| |
Collapse
|