Reconstruction of Scalp with Local Axial Flaps
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ORIGINAL ARTICLE
Reconstruction of Scalp with Local Axial Flaps Pradeep Gupta1 • Saket Srivastava1
Received: 13 August 2020 / Accepted: 25 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract The scalp is a unique part of the human body and various etiological factors, such as tumour extirpation, infection, burns, or trauma, can lead to scalp defects. Primary closure, skin grafting, local flaps, tissue expansion or free tissue transfer are modalities available for scalp reconstruction. In this article, the authors share their institutional experience using various local flaps concerning the size, location, depth of defect and the quality of surrounding tissue. From September 2017 to January 2020, 54 patients underwent scalp reconstruction with local flaps for a sizeable defect size of 5–150 cm2 in the Department of Plastic Surgery, SMS Medical College, Jaipur. Patients were identified by age, sex, cause of the scalp defect; the location, size, and depth of the defect; condition of surrounding tissue and the type of reconstruction done. The most common cause of scalp defect was excision of malignant tumour (50%). 30 patients had a large sized defect (40–90 cm2) and in 28 patients had 90–150 cm2 defects. Surgical reconstruction was done using local flaps, transposition flap was the most used in 36 patients (66.7%) followed by rotation advancement flap in 11 patients (20.4%). The recovery was relatively quick. Minor complications happened in 5 patients (9.3%) that were managed conservatively. In the present era of microsurgical reconstruction, local options as axial flaps provide a simpler and safer method of scalp reconstruction. A carefully planned
& Pradeep Gupta [email protected] & Saket Srivastava [email protected] 1
scalp flap gives healthy, robust, hair-bearing tissue coverage and requires a shorter healing time for the patients. Keywords Scalp Fasciocutaneous flaps Electric burn Reconstructive surgery Cutaneous malignancy
Introduction The scalp is the thickest skin in the human body which covers the pericranium and protects the intracranial structures [1]. Scalp defects may be caused by various etiological factors such as tumour extirpation, infection, burns, trauma, or congenital lesions leading to significant surgical and aesthetic concern [2]. Due to the inelastic galea, the paucity of the adjacent tissue, its limited expandability, and the convexity of its shape, reconstruction of scalp defects is often challenging [3]. Small defects (less than 5 cm2) can be closed primarily; skin grafting is an appropriate option in cases when the pericranium is present. However, in cases of large scalp defects, denuded calvarium exposed dura-mater or CSF leaks; neither primary closure nor skin grafting is applicable. Such injuries require local, distant vascularized flaps or free tissue transfer. Although microvascular tissue transfer has recently been reported to be successful for extensively large scalp defects, local flaps should be considered as the first line of treatment
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