title: Total scalp reconstruction with bilateral anterolateral thigh flaps.
abstract: Large scalp defects can require complicated options for reconstruction, often only achieved with free flaps. In some cases, even a single free flap may not suffice. We review the literature for options in the coverage of all reported large scalp defects, and report a unique case in which total scalp reconstruction was required. In this case, two anterolateral thigh (ALT) flaps were used to resurface a large scalp and defect, covering a total of 743 cm(2). The defect occurred after resection and radiotherapy for desmoplastic melanoma, with several failed skin grafts and local flaps and osteoradionecrosis involving both inner and outer tables of the skull. The reconstruction was achieved as a single-stage reconstruction and involved wide resection of cranium and overlying soft-tissues and reconstruction with calcium phosphate bone graft substitute, titanium mesh, and two large ALT flaps. The reconstruction was successfully achieved, with minor postoperative complications including tip necrosis of one of the flaps and wound breakdown at one of the donor sites. This is the first reported case of two large ALT flaps for scalp resurfacing and may be the largest reported scalp defect to be completely resurfaced by free flaps. The use of bilateral ALT flaps can be a viable option for the reconstruction of large and/or complicated scalp defects.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, Dandenong, Victoria, Australia.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Kwee
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Jeannette W C
authors.initials: JW
authors.lastname: Ting
authors.forename: Mansoor
authors.initials: M
authors.lastname: Mirkazemi
authors.forename: James
authors.initials: J
authors.lastname: Leong
authors.forename: Charles
authors.initials: C
authors.lastname: Baillieu
mesh_terms: D000369:Aged, 80 and over; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008545:Melanoma / Q000532:radiotherapy; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012535:Scalp / Q000528:radiation effects / Q000601:surgery*; D012878:Skin Neoplasms / Q000532:radiotherapy; D012883:Skin Ulcer / Q000209:etiology / Q000601:surgery*; D013848:Thigh