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World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2018

Open Access 01-12-2018 | Research

Reconstruction of composite defects of the scalp and neurocranium—a treatment algorithm from local flaps to combined AV loop free flap reconstruction

Authors: Dominik Steiner, Raymund E. Horch, Ilker Eyüpoglu, Michael Buchfelder, Andreas Arkudas, Marweh Schmitz, Ingo Ludolph, Justus P. Beier, Anja M. Boos

Published in: World Journal of Surgical Oncology | Issue 1/2018

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Abstract

Background

Reconstruction of cranial composite defects, including all layers of the scalp and the neurocranium, poses an interdisciplinary challenge. Especially after multiple previous operations and/or radiation therapy, sufficient reconstruction is often only possible using microsurgical free flap transplantation. The aim of this study was to analyze the therapy of interdisciplinary cases with composite defects including the scalp and neurocranium.

Methods

From 2009 to 2017, 23 patients with 18 free flaps and 10 pedicled/local flaps were analyzed. First choices for free flaps were muscle flaps followed by fasciocutaneous flaps.

Results

Except for four patients, a stable coverage could be reached in the first operation. Three of these patients received a local scalp rotation flap in the first operation and needed an additional free flap because the local flap was no longer sufficient for coverage after wound healing deficiency or tumor relapse. The superficial temporal artery or external carotid artery served as recipient vessels. In special cases, venous grafts or an arteriovenous loop (AV loop) were used as extensions for the recipient vessels.

Conclusions

In summary, an interdisciplinary approach with radical debridement of infected or necrotic tissue and the reconstruction of the dura mater are essential to reach a stable, long-lasting reconstructive result. Based on our experience, free flaps seem to be the first choice for patients after multiple previous operations and/or radiation therapy.
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Metadata
Title
Reconstruction of composite defects of the scalp and neurocranium—a treatment algorithm from local flaps to combined AV loop free flap reconstruction
Authors
Dominik Steiner
Raymund E. Horch
Ilker Eyüpoglu
Michael Buchfelder
Andreas Arkudas
Marweh Schmitz
Ingo Ludolph
Justus P. Beier
Anja M. Boos
Publication date
01-12-2018
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2018
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-018-1517-0

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