title: Aesthetic and oncologic outcome after microsurgical reconstruction of complex scalp and forehead defects after malignant tumor resection: an algorithm for treatment.
abstract: BACKGROUND
  Limited follow-up data on aesthetic outcome and survival after microsurgical reconstruction of complex scalp and forehead defects are available. These data are important to improve reconstruction quality and patient counseling. The purpose of this study was to evaluate surgical, aesthetic, and oncologic outcome of free flap scalp and forehead reconstructions in the patient population of two academic centers.
  
  
  METHODS
  Retrospective data analysis of patients with a microsurgical reconstruction of the scalp or forehead between January of 1999 and June of 2008 was performed. Aesthetic outcome was assessed on a five-point Likert scale for flap color match, contour, and overall aesthetic result.
  
  
  RESULTS
  The group consisted of 84 patients with a mean follow-up time of 27 months (range, 1 to 95 months). Mean defect size was 134 cm (range, 20 to 340 cm), with 46 percent full-thickness bone defects and 16 percent dura defects. The most commonly used free flaps were latissimus dorsi (n = 34) and anterolateral thigh (n = 24). Total flap failure occurred in five patients (6 percent). Disease-free survival and overall survival rates at 5 years were 57 and 65 percent, respectively. Additional operations for aesthetic reasons were performed in 19 patients (23 percent). Panel scores showed a significant lower satisfaction with reconstruction of defects that were located over the frontal scalp compared with other locations (p = 0.004).
  
  
  CONCLUSIONS
  Microsurgical reconstruction in complex scalp and forehead defects is a safe procedure. From the authors' experience, they suggest an algorithm for reconstruction of these complex reconstructive defects that will most likely result in the best aesthetic result.
authors.affiliation: Rotterdam, The Netherlands; Toronto, Ontario, Canada; and Seattle, Wash. From the Department of Plastic and Reconstructive Surgery, Erasmus Medical Center; the Department Otolaryngology-Head and Neck Surgery and the Division of Plastic Surgery, University Health Network; and the Department of Surgery, University of Washington Medical Center.
authors.forename: Antoinette A
authors.initials: AA
authors.lastname: van Driel
authors.forename: Marc A M
authors.initials: MAM
authors.lastname: Mureau
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: Peter C
authors.initials: PC
authors.lastname: Neligan
authors.forename: Stefan O P
authors.initials: SOP
authors.lastname: Hofer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000704:Analysis of Variance; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005546:Forehead / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012535:Scalp / Q000601:surgery; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000098:blood supply*; D015996:Survival Rate; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult