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Abstract
Defects of the scalp and calvarium pose unique reconstructive challenges due to the importance of this area in protecting the brain and its distance from larger donor vessels for free flap transfer. The wide range and complexity of reconstructive options make this a broad topic because the simplest defects are often closed or managed in the outpatient setting and the most complex require multilayer closure in the operating room with a multidisciplinary team and intensive postoperative care. In hair-bearing individuals, the scalp is an esthetically important area due to the importance of hair to self-esteem and sexual attraction.
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Affiliation(s)
- Ciaran Lane
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive MC H091, Hershey, PA 17033, USA.
| | - Alice Lin
- Department of Clinical Sciences, Kaiser Permanente School of Medicine, 4900 Sunset Boulevard 6th Floor, Los Angeles, CA 90027, USA
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive MC H091, Hershey, PA 17033, USA
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Mbaidjol Z, Shaharan S, Christopoulos G, Deraje V, Kannan RY. Fibonacci sequence ‘snail’ flap versus skin grafts in scalp reconstruction: a comparative study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01791-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Poonia SK, Harris BN. Use of xenografts and allografts in scalp reconstruction. Curr Opin Otolaryngol Head Neck Surg 2021; 29:424-428. [PMID: 34374665 DOI: 10.1097/moo.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Scalp reconstruction requires a full array of reconstructive options given the complex anatomy and protection of vital structures. Not all patients qualify for advanced reconstructive options and therefore rely on short, effective procedures with minimal morbidity. This review aims to focus on xenografts and allografts to achieve an adequate reconstruction while minimizing morbidity. RECENT FINDINGS Although bovine xenografts have been used for many decades, there have been recent advances in porcine xenografts to aid in scalp defects. Similarly, new allogenic materials have emerged as additional tools in the armamentarium to promote wound healing. SUMMARY Both xenografts and allografts offer viable options for complex scalp reconstruction.
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Affiliation(s)
- Seerat K Poonia
- University of Pennsylvania, Department of Otolaryngology, Philadelphia, Pennsylvania
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Zhou Y, Jiang Z, Li C, Cai Y, Sun R, Shui C, An C, Tang Z, Sheng J, Liu D, Zeng D, Jiang J, Zhu G, Wang S. An algorithm for one-stage malignant oncologic scalp reconstruction. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:432. [PMID: 32395476 PMCID: PMC7210181 DOI: 10.21037/atm.2020.03.221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Scalp reconstruction has always been a challenging problem after oncological resection. Advanced surgical techniques can reconstruct any defects, but there are a large number of patients who cannot benefit from surgery for immature strategies. The authors here describe an algorithm for selecting the best reconstructive categories and minimizing complications according to the surgical defect of scalp tumors. Methods A single-institution retrospective review was conducted that included 173 patients with scalp tumors treated with surgery followed by reconstruction. Patients were identified by tumor type and nature; the location of scalp defect, size, and depth; the types of reconstructions and surgical. A systematic algorithm was developed according to our findings and current literature. Results Small defects (≤4 cm2) could be closed by primary closure. Medium defects (4–30 cm2) were reconstructed by local flaps. We routinely used skin graft for significant surgical defects (30–90 cm2). And the tumor’s location did not have an impact on reconstructive categories of above three types of defects. Free flaps should reconstruct very large-sized defects (>90 cm2) in frontal, temporal, and vertex locations while pedicle flaps suited for occipital defects due to its anatomic vicinity. The reconstruction algorithm of recurrent disease was like the management in primary tumors except for the medium size defect in the occipital region that was primarily reconstructed by a skin graft. Multiple free flaps reconstruction is the best possibility for total scalp resection. Free flap reconstruction is used mainly for composite resection of the scalp, calvarium, and dura. Conclusions Successful scalp reconstruction requires careful preoperative assessment, flexible and precisely intraoperative management. The algorithm based on defect size, depth, and location can supply some degree of guidelines when considering choosing suitable reconstructive procedures.
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Affiliation(s)
- Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Zhenhua Jiang
- Department of Otolaryngology Head and Neck Surgery, Mianyang Central Hospital, Mianyang 621000, China
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Ronghao Sun
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Chunyan Shui
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Changming An
- Head and Neck Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 10021, China
| | - Zhengqi Tang
- Department of Otolaryngology Head and Neck Surgery, Zigong Third People's Hospital, Zigong 643000, China
| | - Jianfeng Sheng
- Department of Otorhinolaryngology Head and Neck Surgery, Mianyang Third People's Hospital, Mianyang 621000, China
| | - Dingrong Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Neijiang Second People's Hospital, Neijiang 100191, China
| | - Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Jian Jiang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Guiquan Zhu
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Shaoxin Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
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