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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Lessons learned reconstructing complex scalp defects using free flaps and a cranioplasty in one stage
Journal of Craniofacial Surgery, Volume 21, No. 4, Year 2010
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Description
BACKGROUND: The purpose of this study was to review our experience in single-stage reconstruction of skull and scalp defects, aiming to highlight pitfalls in our management. METHODS: We performed a retrospective chart review of all patients who had a single-stage cranioplasty and free-tissue transfer at our institution over the last 10 years. Thirteen patients (9 men and 4 women) with an average age of 66.5 years (range, 34-83 years) were identified. Etiology of the defects included malignancy (n = 7), osteoradionecrosis (n = 3), and infection (n = 3). The size of the bony defect averaged 103.1 cm (range, 12-300 cm). Cranioplasty procedures included reconstruction by methylmethacrylate and titanium mesh (n = 10), methylmethacrylate only (n = 1), or mesh only (n = 2). Free flaps used were anterolateral thigh (n = 10), latissimus dorsi (n = 2), or a rectus flap (n = 1). RESULTS: Five patients (38%) developed at least 1 complication. These included 2 anastomotic problems that were successfully salvaged, 5 cases of wound dehiscence, and 1 mortality due to a respiratory event. Four patients developed a recurrence, and 2 patients required flap contouring at a second stage. Two patients had further reconstruction using 1 (1 patient) or 2 (1 patient) additional free flaps. CONCLUSIONS: Given the complexity of these procedures, the high recurrence rate, and the likelihood of complications, methylmethacrylate is contraindicated in 1-stage cranioplasty and soft-tissue reconstruction in high-risk patients. For unfavorable local conditions (eg previous infection, radiotherapy), the surgeon can either postpone the cranioplasty until the soft-tissue reconstruction has healed, or use a nonanatomical titanium mesh alone. The soft-tissue flap should be harvested of larger dimensions than anticipated. © 2010 by Mutaz B. Habal, MD.
Authors & Co-Authors
Afifi, Ahmed S.
United States, Cleveland
Cleveland Clinic Foundation
Egypt, Giza
Cairo University
Djohan, Risal S.
United States, Cleveland
Cleveland Clinic Foundation
Hammert, Warren
United States, Rochester
University of Rochester
Papay, Francis Anthony
United States, Cleveland
Cleveland Clinic Foundation
Barnett, Addison E.
United States, Cleveland
Cleveland Clinic Foundation
Zins, James E.
United States, Cleveland
Cleveland Clinic Foundation
Statistics
Citations: 62
Authors: 6
Affiliations: 3
Identifiers
Doi:
10.1097/SCS.0b013e3181e17c1e
ISSN:
10492275
Research Areas
Cancer
Health System And Policy
Study Design
Cohort Study
Participants Gender
Male
Female