Abstract
Although the incidence of scalp avulsion has decreased in recent years, it remains
a major concern among plastic surgeons. We therefore aimed to introduce an improved
free flap technique for repairing scalp avulsion with less tissue from the donor site.
This method can achieve maximum primary closure of the donor site and improve its
appearance and function as well as reduce the donor-site morbidity by ensuring that
a smaller free flap can completely cover the scalp defect. Eight patients with scalp
avulsion who had undergone staggered placement of the free flaps were evaluated. Data
on the age, cause of scalp avulsion, scalp defect size, degree of avulsion, postoperative
complications, and follow-up duration were analyzed. The postoperative evaluation
criteria were donor-site sensation, latissimus dorsi muscle strength, upper extremity
function, and quality of life. Patients' mean age was 38.7 years. The main cause of
scalp avulsion was occupation-related accidents. The mean scalp defect size and postoperative
follow-up duration were 26 cm × 20.4 cm and 41.5 months, respectively. One patient
developed flap congestion postoperatively. The wounds at the recipient site healed
well in all patients. There was no significant difference in the sensation between
the surgical and nonsurgical sides. However, the latissimus dorsi muscle strength
significantly differed between both sides. The mental component score, which was used
to assess quality of life, did not significantly differ between the patients and healthy
population, whereas the physical component score significantly differed between the
two groups. None of the included patients had severe upper extremity functional limitation.
Staggered placement of free flaps achieved maximum primary closure of the donor site
and greater scalp avulsion defect coverage with less tissue excised from the donor
site. Importantly, donor-site appearance improved and some donor-site functions were
preserved postoperatively.
Keywords
scalp avulsion - free tissue flaps - latissimus dorsi - serratus anterior - donor-site
morbidity
