Reconstruction of large defects on the scalp and forehead as an interdisciplinary challenge: experience in the management of 39 cases.
OBJECTIVE
To describe options and indications for different surgical reconstruction techniques after resection of large skin tumours on the scalp taking into account an interdisciplinary approach of cranio-maxillofacial surgeon, dermatologist, and neurosurgeon, and to evaluate complications and postoperative outcome.


METHODS
From a total of 39 patients with large skin tumour resections on the scalp and/or the forehead, treated between January 01, 1995 and June 30, 2005, a number of 42 surgical reconstructions were performed. The medical histories, the surgical treatment, postoperative complications, follow-up and outcome were evaluated.


RESULTS
The excision defects measured 146 cm(2) (range: 80.6-546 cm(2)) on average. The most common methods for defect closure were multiple rotation-advancement flaps (n=19). Six patients were treated with split-thickness skin grafts after bone drilling for inducing granulation tissue to grow. Free latissimus dorsi muscle flaps were used in 8 patients and radial forearm flaps in 4 cases. Postoperative complications were rare. An algorithm for the surgical approach to large scalp defects was developed.


CONCLUSIONS
For reconstruction of large defects on the scalp and forehead, various reliable methods may be used with regard to individual patient-specific parameters in cooperation with different medical specialties involved.
Kruse-Lösler
B
B
Department of Cranio-Maxillofacial Surgery, University of Muenster, Waldeyerstrasse 30, D-48129 Muenster, NRW, Germany. losler@uni-muenster.de <losler@uni-muenster.de>
Presser
D
D
Meyer
U
U
Schul
C
C
Luger
T
T
Joos
U
U
D000368:Aged; D005260:Female; D005546:Forehead / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012535:Scalp / Q000473:pathology / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D016896:Treatment Outcome