Subscribe to RSS
DOI: 10.5999/aps.2013.40.4.341
Vascularized Bipedicled Pericranial Flaps for Reconstruction of Chronic Scalp Ulcer Occurring after Cranioplasty
Background Intractable chronic scalp ulcers with cranial bone exposure can occur along the incision after cranioplasty, posing challenges for clinicians. They occur as a result of severe scarring, poor blood circulation of the scalp, and focal osteomyelitis. We successfully repaired these scalp ulcers using a vascularized bipedicled pericranial flap after complete debridement.
Methods Six patients who underwent cranioplasty had chronic ulcers where the cranial bone, with or without the metal plate, was exposed along the incision line. After completely excising the ulcer and the adjacent scar tissue, subgaleal dissection was performed. We removed the osteomyelitic calvarial bone, the exposed metal plate, and granulation tissue. A bipedicled pericranial flap was elevated to cover the defect between the bone graft or prosthesis and the normal cranial bone. It was transposed to the defect site and fixed using an absorbable suture. Scalp flaps were bilaterally advanced after relaxation incisions on the galea, and were closed without tension.
Results All the surgical wounds were completely healed with an improved aesthetic outcome, and there were no notable complications during a mean follow-up period of seven months.
Conclusions A bipedicled pericranial flap is vascularized, prompting wound healing without donor site morbidity. This may be an effective modality for treating chronic scalp ulcer accompanied by the exposure of the cranial bone after cranioplasty.
This article was presented at the 70th Congress of the Korean Society of Plastic and Reconstructive Surgeons on November 9, 2012 in Seoul, Korea.
Publication History
Received: 20 March 2013
Accepted: 07 May 2013
Article published online:
01 May 2022
© 2013. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Argenta LC, Friedman RJ, Dingman RO. et al. The versatility of pericranial flaps. Plast Reconstr Surg 1985; 76: 695-702
- 2 Al-Qattan MM. The use of multifolded pericranial flaps as "plugs" and "pads". Plast Reconstr Surg 2001; 108: 336-342
- 3 Potparic Z, Fukuta K, Colen LB. et al. Galeo-pericranial flaps in the forehead: a study of blood supply and volumes. Br J Plast Surg 1996; 49: 519-528
- 4 Boeckx WD, van der, Nanhekhan LV. et al. The role of free flaps in the treatment of persistent scalp osteomyelitis. Neurosurgery 2006; 59: ONS64-ONS67
- 5 Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg 2005; 116: 54e-72e
- 6 Lutz BS, Wei FC, Chen HC. et al. Reconstruction of scalp defects with free flaps in 30 cases. Br J Plast Surg 1998; 51: 186-190
- 7 Nakadai M, Takahashi H, Taniguchi M. et al. Repair of widely infected scalp defect and osteomyelitis with free radial forearm flap: a case report. No Shinkei Geka 1991; 19: 655-659
- 8 Karsidag S, Ozcan A, Ozkaya O. et al. Use of wide bipedicled pericranial flap in anterior scalp reconstruction. J Craniofac Surg 2009; 20: 2248-2251
- 9 Tolhurst DE, Carstens MH, Greco RJ. et al. The surgical anatomy of the scalp. Plast Reconstr Surg 1991; 87: 603-612
- 10 Burm JS, Oh SJ. Prevention and treatment of wide scar and alopecia in the scalp: wedge excision and double relaxation suture. Plast Reconstr Surg 1999; 103: 1143-1149