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Scalp reconstruction requires keen insight into underlying anatomy and surgical armamentarium. The reconstructive surgeon must consider a plethora of complexities to devise a safe and cosmetically maximized outcome. The purpose of this article is to review scalp reconstruction techniques and the current literature in the framework of the reconstruc...
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Background: Scalp reconstruction requires knowledge of scalp anatomy and reconstructive options. Advances in the field have led to numerous procedures being at the disposal of the reconstructive surgeon, expanding treatment options for patients. Objective: To provide an algorithmic approach and general guidelines to consider when deciding on which...
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... Several articles in the literature discuss comprehensive algorithms for scalp reconstruction; however, such detailed approaches are beyond the scope of this review [19][20][21]. Local and regional flaps typically provide stable coverage of scalp defects, but their availability may be limited due to prior surgery, radiotherapy, or scarring ( Figure 2) [22,23]. Free tissue flaps have high survival rates and may be necessary for large scalp defects, which can result in donor-site morbidity, increased hospitalization length, and higher overall cost [24,25]. ...
Background: Skin substitutes play a crucial role in wound care by actively modulating the wound healing process, promoting angiogenesis, and protecting the integrity of the native extracellular matrix. Consequently, surgeons have increasingly recognized these resources as excellent complements to improve reconstructive outcomes. This review focuses on the author’s experience using these biomaterials in complex cases, highlighting the benefits they bring to patient care. Methods: A literature review was conducted to evaluate the regenerative properties of skin substitutes and their applicability in head and neck, upper and lower extremities, and trunk reconstruction. Results: The reviewed literature, along with the authors’ experience, supports the adjunct use of skin substitutes in various reconstructive situations. Combining them with skin grafts improves resulting skin quality and may also enhance donor site healing. They have proven to be effective in addressing chronic venous ulcers, traumatic wounds with limited donor tissues for coverage, extensive burns, diabetic foot ulcers, and oncological resections in the face and scalp. Furthermore, combining them with autologous tissue shows promising results in achieving stable closure. Conclusions: Incorporating skin substitutes in complex reconstructive scenarios offers multiple benefits. Their regenerative properties and ability to modulate the healing process contribute to enhanced outcomes and reduced overall costs.
... Due to the wide variety of patient history and clinical presentation of scalp defects, utilization of the reconstructive ladder provides surgeons with a method to determine the best procedure for each patient. The ladder proceeds in the following manner: secondary intention, primary closure, advancement flaps, rotation flaps, skin grafts, tissue expansion, and free tissue transfer [4]. The ladder begins with simpler procedures, increasing in complexity further up the ladder [7,9]. ...
... When planning the closure of the wound, tension should not be placed on the skin itself which could result in alopecia and dehiscence. Instead, tension should be focused on the galea as it is deep to the hair follicles and can withstand the added force of closure [4,13]. Skin grafting and free tissue transfer should be avoided, unless there are no other options, due to poor cosmetic results. ...
... Small defects are amenable to be treated with primary closure [4]. Secondary intention could be used in this circumstance though this is best suited for those with androgenetic alopecia, where the scars are less conspicuous, than for those who still have hair. ...
Background: Scalp reconstruction requires knowledge of scalp anatomy and reconstructive options. Advances in the field have led to numerous procedures being at the disposal of the reconstructive surgeon, expanding treatment options for patients. Objective: To provide an algorithmic approach and general guidelines to consider when deciding on which scalp surgery will optimize cosmetic and functional outcomes. Methods & materials: Previous literature was searched for the last 20 years to provide an updated guide. Results: Taking into consideration the location, size and local scalp anatomy of a presenting defect will lead to optimal surgical outcomes. Other confounding factors such as bone exposure and extremely large defects will affect decision making. An algorithmic approach has been provided in this review. Conclusion: While many reconstructive surgical options are available, the best ones will depend on individual presentation of scalp defects. Location and size are first line considerations while local scalp anatomy will allow for tailoring of reconstructive options. This will help to maximize cosmetic and aesthetic considerations.
Nghiên cứu nhằm đánh giá kết quả sử dụng vạt tại chỗ trong tạo hình che phủ khuyết tổ chức da đầu sau cắt bỏ ung thư biểu mô tế bào đáy. Nghiên cứu can thiệp lâm sàng không nhóm chứng trên 15 bệnh nhân (8 nam và 7 nữ, tuổi từ 56 tới 90), được phẫu thuật tạo hình bằng vạt tại chỗ che phủ khuyết da đầu sau cắt bỏ ung thư biểu mô tế bào đáy tại khoa Ngoại đầu cổ Bệnh viện K từ tháng 5/2018 tới tháng 5/2022. Kết quả được đánh giá trong quá trình nằm viện và sau mổ > 6 tháng. Tổn khuyết sau cắt bỏ khối u có kích thước từ 7,07cm2 tới 58,90cm2, các tổn khuyết này được che phủ bằng 7 vạt chuyển, 5 vạt đẩy và 4 vạt xoay. Sau mổ 100% vạt sống hoàn toàn và che phủ hết tổn khuyết, 5 trường hợp chậm liền vết mổ, không có trường hợp nào nhiễm trùng. Theo dõi sau 6 tháng trên 15 bệnh nhân cho kết quả tốt về sẹo, tương đồng màu sắc, độ dày vạt, không co kéo xung quanh; 9/13 vạt da đầu mang tóc có tình trạng mọc tóc tốt. Kết quả nghiên cứu cho thấy tạo hình khuyết tổn sau cắt bỏ ung thư biểu mô tế bào đáy vùng da đầu bằng vạt tại chỗ đem lại kết quả tốt về chức năng, thẩm mĩ. Vị trí và kích thước tổn khuyết là các yếu tố chính ảnh hưởng tới loại vạt sử dụng.
