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The Efficacy of Local Flaps in the Treatment of Traumatic Scalp Defects
Background Scalp defects represent a therapeutic challenge. The aim of this study is to present our experience with local and regional flaps in the treatment of trauma-induced scalp defects. Furthermore, a comparison with other surgical techniques was performed.
Methods A retrospective evaluation of patient records was performed. Only patients who underwent surgery using local flaps between January 2010 and September 2020 due to traumatic scalp defects were included in the study.
Results In all, 10 cases were identified (3 females, 7 males, average age at surgery of 46.5 years [range: 18–82 years]). Six patients underwent surgery due to tissue defects and four due to scar keloids. Three patients experienced minor postoperative complications, one of which required additional surgery. The mean defect size was 35.75 cm2 (range: 4–79 cm2) among the four patients where the defect size could be determined retrospectively. The mean inpatient follow-up was 12.4 days (range: 2–34 days).
Conclusions Local flaps can be widely used. In carefully selected cases, they have the fewest disadvantages of all surgical techniques. In our experience, large angiosomes of the main scalp arteries allow the treatment of defects larger than 30 cm2 with local flaps. Our experience also suggests that the dimensions of flap length to flap width can exceed a ratio of 2:1 in the scalp.
Received: 26 November 2020
Accepted: 12 February 2021
Article published online:
15 November 2021
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- 1 Desai SC, Sand JP, Sharon JD, Branham G, Nussenbaum B. Scalp reconstruction: an algorithmic approach and systematic review. JAMA Facial Plast Surg 2015; 17 (01) 56-66
- 2 Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg 2005; 116 (04) 54e-72e
- 3 Angelos PC, Downs BW. Options for the management of forehead and scalp defects. Facial Plast Surg Clin North Am 2009; 17 (03) 379-393
- 4 Blackwell KE, Rawnsley JD. Aesthetic considerations in scalp reconstruction. Facial Plast Surg 2008; 24 (01) 11-21
- 5 Janis JE, Kwon RK, Attinger CE. The new reconstructive ladder: modifications to the traditional model. Plast Reconstr Surg 2011; 127 (Suppl. 01) 205S-212S
- 6 Simman R. Wound closure and the reconstructive ladder in plastic surgery. J Am Col Certif Wound Spec 2009; 1 (01) 6-11
- 7 Gottlieb LJ, Krieger LM. From the reconstructive ladder to the reconstructive elevator. Plast Reconstr Surg 1994; 93 (07) 1503-1504
- 8 Ratner D. Skin grafting. From here to there. Dermatol Clin 1998; 16 (01) 75-90
- 9 Orticochea M. Four flap scalp reconstruction technique. Br J Plast Surg 1967; 20 (02) 159-171
- 10 Orticochea M. New three-flap reconstruction technique. Br J Plast Surg 1971; 24 (02) 184-188
- 11 Seery GE. Surgical anatomy of the scalp. Dermatol Surg 2002; 28 (07) 581-587
- 12 Koga N. Soft tissue of the scalp and temporal regions. In: Watanabe K, Shoja MM, Loukas M, Tubbs RS. eds. Anatomy for Plastic Surgery of the Face, Head, and Neck. New York, NY: Thieme; 2016: 33-39
- 13 Cormack GC, Lamberty BGH. The blood supply to the skin by regions Head and neck. In: Bromage M, Kullar S. eds. The Arterial Anatomy of Skin Flaps. 2nd ed.. New York, NY: Churchill Livingstone; 1994: 131-141
- 14 Sebastian S. Does preoperative scalp shaving result in fewer postoperative wound infections when compared with no scalp shaving? A systematic review. J Neurosci Nurs 2012; 44 (03) 149-156
- 15 Zingaretti N, De Biasio F, Riccio M, Marchesi A, Parodi PC. An efficient method for hair containment during head and neck surgery. J Craniofac Surg 2017; 28 (08) e734-e735
- 16 Mitsukawa N, Saiga A, Kubota Y, Satoh K. Hair braiding method to prevent hair from entering the operating field on the scalp. J Craniofac Surg 2013; 24 (03) e206-e207
- 17 Camarata JC, Wang PT. Hair sparing techniques and scalp flap design. Neurosurg Clin N Am 2002; 13 (04) 411-419
- 18 Seery GE. Scalp surgery: anatomic and biomechanical considerations. Dermatol Surg 2001; 27 (09) 827-834
- 19 Raposio E, Santi PL, Nordström RE. Serial scalp reductions: a biomechanical approach. Dermatol Surg 1999; 25 (03) 210-214