Successful reconstruction of scalp and skull defects: lessons learned from a large series.
OBJECTIVE
To provide a framework for the management of scalp and skull defects.


METHODS
Retrospective chart review.


METHODS
Two tertiary care hospitals.


METHODS
Fifty-six consecutive patients who underwent reconstruction of scalp and/or skull defects with free flaps, rotational skin/fascia flaps, skin grafts, and implants. Defects closed primarily and those of the lateral temporal bone and skull base were excluded.


RESULTS
Sixty-two reconstructions were performed. Treatment of skin cancers and intracranial tumors necessitated 31 (50%) and 22 (35%) of the reconstructions, respectively. Defects included partial-thickness soft tissue (9, 15%), full-thickness soft tissue (28, 45%), full-thickness soft tissue and skull (17, 27%), and full-thickness soft tissue, skull, and dura (8, 13%). Radiation or prereconstruction wound breakdown or infection was involved in 33 (53%) and 25 (40%) of cases, respectively. The most common method of reconstruction was free tissue transfer (27, 44%) followed by local skin (15, 24%) or fascia (9, 15%) flaps. There was a 15% (9/62) complication rate; 89% (8/9) of these occurred in radiated tissues and 44% (4/9) occurred in smokers. Seven of the nine patients with complications (78%) were managed with local wound care and/or removal of an implant, whereas 2 (22%) required a second reconstructive procedure. All patients ultimately achieved a safe outcome with no infection and no bone or dural exposure.


CONCLUSIONS
In addition to defect location and extent, availability of surrounding tissue and wound healing characteristics direct reconstruction. Patients who receive radiation therapy are at increased risk of complications. Use of vascularized tissue is critical for successful management, making local flaps and free tissue transfer the mainstay of reconstruction.
Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA. dcs5z@virginia.edu
David C
DC
Shonka
Andrea E
AE
Potash
Mark J
MJ
Jameson
Gerry F
GF
Funk
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D001932:Brain Neoplasms / Q000601:surgery*; D006259:Craniocerebral Trauma / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D020366:Methylmethacrylate; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012535:Scalp / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods*; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps
D001843:Bone Cements; D020366:Methylmethacrylate