Scalp Rotation Flap for Reconstruction of Complex Soft Tissue Defects

Abstract

Importance Scalp reconstructions may be required after tumor resection or trauma. The inherent anatomy of the scalp presents challenges and may limit reconstructive options.

Objective To describe and investigate the scalp rotation flap as a reconstructive technique for complex soft tissue defects.

Design Retrospective case series with a mean follow-up of 13 months.

Setting Tertiary academic center.

Participants A total of 22 patients with large scalp soft tissue defects undergoing scalp rotation flap reconstruction.

Interventions The flap is designed adjacent to the defect and elevated in the subgaleal plane. The flap is rotated into the defect, and a split-thickness skin graft is placed over the donor site periosteum.

Main Outcomes and Measure Data points collected included defect size, operative time, hospital stay, and patient satisfaction with cosmetic outcome.

Results Mean patient age was 71 years. Mean American Society of Anesthesiologist classification was 2.8. Mean defect size was 41 cm² (range: 7.8–120 cm²), and 19 of 22 defects resulted from a neoplasm resection. Mean operative time was 181 minutes, and mean hospital stay was 2.4 days. There were no intraoperative complications. Three patients with previous radiation therapy had distal flap necrosis. Twenty-one patients (95%) reported an acceptable cosmetic result.

Conclusions and Relevance The scalp rotation flap is an efficient and reliable option for reconstructing complex soft tissue defects. This can be particularly important in patients with significant medical comorbidities who cannot tolerate a lengthy operative procedure.

Keywords

oncology - scalp reconstruction - reconstruction - local flap

Note

The principal investigator (D.C.) had access to all of the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

• References

• 1 Rogers HW, Coldiron BM. Analysis of skin cancer treatment and costs in the United States Medicare population, 1996–2008. Dermatol Surg 2013; 39 (1 Pt 1): 35-42
• 2 Vecchione TR, Griffith L. Closure of scalp defects by using multiple flaps in a pinwheel design. Plast Reconstr Surg 1978; 62 (1) 74-77
• 3 Arpey CJ. Random-pattern flaps. In: Arpey CJ, Whitaker DC, O'Donnell MJ, eds. Cutaneous Surgery: Illustrated and Practical Approach. New York, NY: McGraw-Hill; 1997: 222
• 4 Bo B, Qun Y, Zheming P, Haitao X, Tianyi L. Reconstruction scalp defects after malignant tumor resection with anterolateral thigh flaps. J Craniofac Surg 2011; 22 (6) 2208-2211
• 5 Sweeny L, Eby B, Magnuson JS, Carroll WR, Rosenthal EL. Reconstruction of scalp defects with the radial forearm free flap. Head Neck Oncol 2012; 4 (4) 21
• 6 Hierner R, van Loon J, Goffin J, van Calenbergh F. Free latissimus dorsi flap transfer for subtotal scalp and cranium defect reconstruction: report of 7 cases. Microsurgery 2007; 27 (5) 425-428
• 7 Tanaka K, Sakuraba M, Miyamoto S , et al. Analysis of operative mortality and post-operative lethal complications after head and neck reconstruction with free tissue transfer. Jpn J Clin Oncol 2011; 41 (6) 758-763
• 8 Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg 2005; 116 (4) 54e-72e
• 9 Becker GD, Adams LA, Levin BC. Secondary intention healing of exposed scalp and forehead bone after Mohs surgery. Otolaryngol Head Neck Surg 1999; 121 (6) 751-754
• 10 Tolhurst DE, Carstens MH, Greco RJ, Hurwitz DJ. The surgical anatomy of the scalp. Plast Reconstr Surg 1991; 87 (4) 603-612 ; discussion 613–614
• 11 Angelos PC, Downs BW. Options for the management of forehead and scalp defects. Facial Plast Surg Clin North Am 2009; 17 (3) 379-393
• 12 Earnest LM, Byrne PJ. Scalp reconstruction. Facial Plast Surg Clin North Am 2005; 13 (2) 345-353 , vii
• 13 Raposio E, Santi PL, Nordström RE. Serial scalp reductions: a biomechanical approach. Dermatol Surg 1999; 25 (3) 210-214
• 14 Temple CL, Ross DC. Scalp and forehead reconstruction. Clin Plast Surg 2005; 32 (3) 377-390 , vi–vii
• 15 Beasley NJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, Neligan PC. Scalp and forehead reconstruction using free revascularized tissue transfer. Arch Facial Plast Surg 2004; 6 (1) 16-20
• 16 Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 1999; 103 (2) 403-411
• 17 Farwell DG, Reilly DF, Weymuller Jr EA, Greenberg DL, Staiger TO, Futran NA. Predictors of perioperative complications in head and neck patients. Arch Otolaryngol Head Neck Surg 2002; 128 (5) 505-511
• 18 Suh JD, Sercarz JA, Abemayor E , et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2004; 130 (8) 962-966