Abstract
Background Scalp reconstruction in plastic and reconstructive surgery often necessitates the
transfer of soft-tissue flaps to restore form and function. The critical decision
lies in choosing between muscle-containing (MC) and fasciocutaneous (FC) flaps for
scalp reconstruction, and while both variants have their merits, flap composition
remains a subject of ongoing debate. This scientific discussion aims to explore this
contentious issue through a comprehensive meta-analysis, shedding light on the rationale
behind the choice of these flaps and the potential impact on clinical outcomes.
Methods A comprehensive systematic review was conducted following PRISMA-P guidelines, encompassing
six prominent databases up to the year 2023. Data were collected from studies assessing
outcomes of MC and FC flaps for scalp reconstruction. Quality evaluation was performed
using ASPS criteria and the ROBINS-I tool. Statistical analysis included descriptive
statistics, meta-analysis, sensitivity analysis, and assessment of bias using STATA
software.
Results The meta-analysis included 28 nonrandomized studies, totaling 594 flaps (MC: 380,
FC: 214). MC flaps were significantly larger than FC flaps. There were no significant
differences in flap loss, flap necrosis, or wound dehiscence between the two flap
types. However, the incidence of venous congestion was significantly higher in FC
flaps. Sensitivity analysis confirmed the robustness of results, and publication bias
assessment showed no significant evidence of bias.
Conclusion While both MC and FC flaps offer viable options for scalp reconstruction, the choice
should be tailored to individual patient characteristics and defect size. FC flaps
may provide advantages such as shorter operative times and reduced morbidity, whereas
MC flaps could be preferred for addressing larger defects. Future research should
focus on prospective studies and strategies to mitigate venous congestion in FC flaps,
enhancing their safety and efficacy in scalp reconstruction.
Keywords
flap - scalp reconstruction - muscle - fasciocutaneous - myocutaneous
