Extended Scalp Expansion for Larger Defects During Staged Cranioplasty

Basal cell carcinoma of the scalp: surgical approach and reconstructive options

INTRODUCTION

Surgical therapy of basal cell carcinomas (BCC) is based on complete excision of the neoplasm and its immediate suitable reconstruction. The aim of this work was to evaluate the possibility of creating a reconstructive algorithm in cases of scalp BCC, depending on the amplitude of the tumor.

EVIDENCE ACQUISITION

A literature search was carried out using the databases of PubMed, Scopus and Cochrane.

EVIDENCE SYNTHESIS

Based on the experiences reported in the literature, it was possible to structure a decision-making algorithm that summarizes the various steps involved in the choice of the most suitable reconstructive surgical therapy.

CONCLUSIONS

The algorithm described we hope will be of reference or help to less experienced reconstructive plastic surgeons.

Application of Skin-stretching Device for Closing Scalp Defect

BACKGROUND

The scalp defect was a clinical common constructive challenge. This research verified the efficacy of the skin-stretching device in the treatment of scalp defect and assessed the associated complications.

METHODS

The clinical data of 12 patients with scalp defect treated with skin-stretching device from January 2020 to January 2021 were collected. We used EASApprox skin-stretching device for the treatment of scalp defect. We described a detailed reconstruction procedure for this treatment. We collected the site, distance from wound edge and other characteristics of the wound, and recorded the number of stretching cycles, operation time, closed state, healing time, and observed postoperative complications and wound healing status.

RESULTS

In this research, the scalp defect was mainly caused by pressure ulcer, and mainly located in the parietooccipital site. The average distance from wound edge was 3.2 cm, the average stretching cycles was 4.2 times during the operation, and the average operation time was 43.5 minutes. Ten patients were directly sutured after stretching, and 2 patients underwent first-stage stretching to reduce the wound. The average time of wound healing was 13.5 days. Postoperative follow-up of 3 months, no patients had wound tear, necrosis, 1 patient suffered from wound exudation and infection due to poor nutrition. Skin function and final scar was acceptable.

CONCLUSION

The treatment of skin-stretching device was effective for scalp defect and has the advantages of convenient operation, acceptable functional results, without severe complications. In addition to traditional treatment, this was a promising treatment. However, more clinical and preclinical research of the skin-stretching device were required.

Large Scalp Defect Reconstruction With Tissue Expansion, Orticochea Flap, and Acellular Dermal Matrix for Soft Tissue Augmentation: A Case Report

Reconstruction of a large scalp defect following oncologic surgical resection is a challenging task. The defect size, location, and elasticity of the soft tissue overlying the calvarium are important factors to be considered when exploring available reconstructive options. When primary closure is not feasible with a large defect, a skin flap or graft is utilized. Skin flap is advantageous as it produces a similar color and texture as the surrounding areas, thus being the favorable method. Wounds involving exposed bone, tendon, and cartilage cannot support grafts due to poor vascularity and thus require a skin flap. One of the multi-flap closure modalities, the Orticochea flap, is an excellent choice for scalp reconstruction on large defects greater than 50 cm². We present an interesting case of a patient with a large scalp defect following Mohs surgery of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) that was successfully reconstructed with tissue expansion utilizing Orticochea flap, with the addition of an acellular dermal matrix as an adjunct in such hostile scalp reconstruction.