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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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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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  • presenting/speaker Niklas Thon - Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, Neurochirurgie, München, Deutschland
  • Florian Oehlschlägel - Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, Neurochirurgie, München, Deutschland
  • Niclas Broer - Klinikum Bogenhausen, Klinik für Plastische, Rekonstruktive, Hand- und Verbrennungschirurgie, München, Deutschland
  • Konstantin Koban - Klinikum der Ludwig-Maximilians-Unversität – Campus Großhadern, Hand-, Plastische- und Ästhetische Chirurgie, München, Deutschland
  • Riccardo Giunta - Klinikum der Ludwig-Maximilians-Unversität – Campus Großhadern, Hand-, Plastische- und Ästhetische Chirurgie, München, Deutschland
  • Denis Ehrl - Klinikum der Ludwig-Maximilians-Unversität – Campus Großhadern, Hand-, Plastische- und Ästhetische Chirurgie, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP156

doi: 10.3205/19dgnc493, urn:nbn:de:0183-19dgnc4938

Published: May 8, 2019

© 2019 Thon et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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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.