FREE FLAP OPTIONS FOR RECONSTRUCTION OF COMPLICATED SCALP AND CALVARIAL DEFECTS: REPORT OF A SERIES OF CASES AND LITERATURE REVIEW

Objective: The advent of free tissue transfer has offered several options that allow the restoration of both the structural and functional defects of the scalp and calvaria caused by malignant tumors or sequelae after trauma. This study aims to investigate the free flap options for complicated scalp and calvarial reconstructions. Methods: There were 12 free tissue transfers used to reconstruct scalp and calvarial defects in this study, with nine acute or subacute wounds resulting from trauma or cranietomy, two congenital hydrocephalus post ventriculo-peritoneal shunting and one primary cancer. They consisted of five fasciocutaneous flaps (four anterolateral thigh fasciocutaneous flaps and one deep inferior epigastric perforator flap) and seven myocutaenosu flaps (five anterolateral thigh myocutaneous flaps and two rectus abdominis myocutaneous flaps). Results: The overall flap success rate was 100%. There were no major complications except for one where wound dehiscence was caused by hematoma accumulation and was healed by local debridement. All donor sites underwent primary closure except for three receiving split-thickness skin grafting after bulky anterolateral thigh flap harvest. No major donor-site morbidity was observed except for one patient with some graft loss. Conclusions: With its evident structural and functional advantages, fasciocutaneous flaps were suitable for larger scalp defect only and myocutaneous flaps can be considered as an excellent reconstructive option for complicated scalp and calvarial defects, especially where dead space coexists. (C) 2009 Wiley-Liss, Inc. Microsurgery 30:13-18, 2010.