gms | German Medical Science

126. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2009, München

Treatment of skin malignancies of the scalp – a reconstructive algorithm

Meeting Abstract

  • corresponding author N. Iblher - Abteilung für Plastische und Handchirurgie, Uniklinik Freiburg
  • V. Penna - Abteilung für Plastische und Handchirurgie, Uniklinik Freiburg
  • G.B. Stark - Abteilung für Plastische und Handchirurgie, Uniklinik Freiburg
  • H. Bannasch - Abteilung für Plastische und Handchirurgie, Uniklinik Freiburg

Deutsche Gesellschaft für Chirurgie. 126. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09dgch10938

DOI: 10.3205/09dgch308, URN: urn:nbn:de:0183-09dgch3084

Published: April 23, 2009

© 2009 Iblher et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Introduction: Neoplasms of the scalp are a very common disease and although the exposed localisation facilitates early detection, diagnosis and treatment, advanced cases with increasing locoregional infiltration are not rare. While newer therapies including immunotherapy, advanced methods of radiation and new chemotherapies are constantly emerging the mainstay of a curative therapeutic concept still is and will be the radical resection of these tumors. In more advanced cases the radicality of the resection should not be sacrificed due to an assumed inability to cover the resultant defect. The modern armamentarium of plastic surgeons allows coverage for almost any extend of resection for advanced scalp tumors. It seems unacceptable to route patients into the direction of a palliative therapy because defect coverage is not possible within the respective institution.

Material and methods: Since many different medical specialties are primarily approached by respective patients we see a need for a clear algorithm facilitating the decision for referal if simpler defect coverage options are not possible.Based on 78 patients with scalp neoplasms treated in our departement from 1998 through June 2008 we developed an algorithm that describes defect coverage options of the scalp after radical tumor resection. In this algorithm we especially aim to describe clear limits of respective reconstructive techniques rather than to describe certain techniques in detail. Based on the tumor type, the size of the tumor, the localisation within the scalp and further affected structures we present an algorithm for possible defect coverage options.

Results: More complex and advanced tumors call for more complex reconstructive methods. Primary closure is only feasible in tumor exzisions up to 3 to 4 cm of size. The next step local skalp flaps provide a good and aesthetically advantageous solution of tumors up to 6-7 cm in diameter, especially when placed centrally within the scalp and reconstruction of hear bearing skin is of interest. In larger tumors free tissue transfer is the most flexible solution. Different types of free flaps are Exemplary cases of the different steps of this specialized reconstructive ladder are demonstrated.

Conclusion: Safe yet radical resektion of scalp tumors is possible if the right reconstructive methods are chosen in advance. Resectability should hardly ever be restricted due to questions of resultant defect coverage.