Reconstruction of the scalp with a calvarial defect.
OBJECTIVE
To review our clinical cases and devise a protocol for selecting the best operative methods to reconstruct the scalp with a calvarial defect.


METHODS
We reviewed the original disease, the areas and depths of the scalp and calvarial defects, the methods of reconstruction, and complications in 20 patients.


RESULTS
The defect was caused by secondary cranial infection following decompressive craniectomy for intracranial hemorrhage (ICH) in 11 patients; extensive removal of the scalp and calvaria for resection of a malignant tumor in 6 patients; and by secondary cranial infection following removal of a malignant tumor in 3 patients. Cranial infection was frequently associated with abscess formation around the fixation screws and plates, suggesting that artificial materials induced the infection. We reconstructed the defect using free flaps in 15 patients and using local flaps in 5 patients.


CONCLUSIONS
When restoring the calvaria in the primary operation, the use of metal screws and plates should be minimized to prevent cranial infection and subsequent scalp and calvaria defects. Local flaps are appropriate for reconstructing relatively small defects (<20 cm(2)), whereas free flaps are better for reconstructing relatively large defects (>25 cm(2)).
Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
Tomohisa
T
Nagasao
Takashi
T
Horiguchi
Junpei
J
Miyamoto
Kazuo
K
Kishi
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007239:Infections / Q000473:pathology; D020300:Intracranial Hemorrhages / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012535:Scalp / Q000601:surgery*; D012886:Skull / Q000473:pathology*; D012888:Skull Neoplasms / Q000150:complications; D013524:Surgical Flaps
Microsurgery. 2007;27(5):425-8
17596862
Plast Reconstr Surg. 2002 May;109(6):1828-34
11994580
Plast Reconstr Surg. 1992 Feb;89(2):349-52
1732907
Eur J Surg Oncol. 2006 Nov;32(9):1006-14
16806795
J Surg Oncol. 2006 Nov 1;94(6):504-8
17061273
Br J Plast Surg. 2003 Dec;56(8):784-90
14615253
Head Neck. 2004 Jan;26(1):46-53
14724906
Ann Plast Surg. 1996 Dec;37(6):629-32
8988776
J Neurosurg. 2004 Feb;100(2 Suppl Pediatrics):163-8
14758944
Ann Plast Surg. 1993 Mar;30(3):267-71
8494310
J Plast Reconstr Aesthet Surg. 2007;60(10):1158-61
17825780
Chin J Traumatol. 2003 Apr;6(2):99-103
12659705
Int J Oral Maxillofac Surg. 1997 Oct;26(5):331-5
9327281
Plast Reconstr Surg. 2007 Mar;119(3):865-72
17312489