Artikel
Scalp reconstruction after resection of malignant scalp tumours – an analysis and treatment algorithm
Plastische Deckung nach Resektion von bösartigen Kopfhauttumoren – eine Analyse und Behandlungsalgorithmus
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Veröffentlicht: | 8. Mai 2019 |
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Objective: This study aimed to evaluate the outcome of microvascular-based scalp reconstructions (MSR) after malignant scalp tumor resections.
Methods: Within a 5-year period, 38 patients having undergone 41 MSR (15 antero-lateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections were included. Retrospective data included patients’ demographics, tumor characteristics, surgical results, and outcome.
Results: Mean age was 69 (±12.3) years. Malignant tumors showed superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. Dural repair was needed in 8 patients and concomitant bone replacement in 24 cases. MSR was always performed after histological approved complete tumor resection. LDM flaps were used for larger defect sizes of 400–1250 cm2, whereas ALT- and GM-flaps were chosen for defects ranging from 40–350 cm2 (p<0.05). The average length of the pedicle was significantly longer in ALT- and LDM-, compared to GM-flaps (p<0.05). Postoperative cerebrospinal fluid leakage was seen in four cases. Total flap loss occurred in 9.8% of patients.
Conclusion: Microsurgical reconstruction of moderate to extensive scalp defects remains a reliable method, while muscle flaps show the best functional and aesthetic results. In cases of central scalp defects and in situations when a long vascular pedicle of the flap is important, the ALT flap seems to be the best solution.