Recent and Different Modalities in Reconstruction of Scalp (Anterior Hair Line)
Ahmad Nagy Muhammad;
Abstract
Scalp reconstruction is a “continuous challenge” for the usual activity of the plastic surgeon due to searching for an option which provides a good aesthetic outcome as well as durable coverage.
Knowledge of the anatomy of the scalp and forehead will assist the reconstructive surgeon in the choice of local flap options as well as choosing a potential microsurgical recipient vessels site if needed.
Scalp defects are due to several causes such as trauma (mechanical, thermal, chemical), tumor resection, congenital anomalies (aplasia cutis, vascular malformations, and nevus), inflammation, radiation, and chemotherapy.
There are many surgical methods for reconstruction of the scalp e.g primary closure, secondary intention, skin graft, local flaps, distant flaps, and free tissue transfer. Also there are other recent procedures that may be used such as tissue expansion, artificial dermis then skin graft and surgical hair transplantation.
As the type of surgical procedure depends on the size, location and the depth of the defect, Primary closure is suitable for small defects (< 3cm). Secondary intention is useful in patients (smokers, patients who have a history of local radiation) whom condition will interfere with the success of flaps or grafting. Skin graft has a role in temporary covering of the defects until healing occurs then definite treatment is done.
Flaps are the most used options when reconstructing the scalp. They are classified into: local, distant, and free. Local flaps are more commonly used for reconstruction. There are different types of local flaps used e.g single or multiple rotation advancement flaps, VY or H-shaped advancement flaps, transposition flaps, bilobed flaps. They are used for small to moderate-sized defects.
Distant flaps like trapezius muscle and latissimus dorsi muscle flap may be alternative option when large defect (>25 cm2), exists. They can cover large defects especially in the occipital region.
Free tissue transfer offers a one-step solution for resurfacing large scalp defects especially if more than 120 cm2 and produces surprisingly good results, especially in patients with preexisting alopecia. The flaps most commonly used for scalp and forehead reconstruction are the anterolateral thigh (ALT) flap, the latissimus dorsi muscle flap, and the radial forearm flap.
Knowledge of the anatomy of the scalp and forehead will assist the reconstructive surgeon in the choice of local flap options as well as choosing a potential microsurgical recipient vessels site if needed.
Scalp defects are due to several causes such as trauma (mechanical, thermal, chemical), tumor resection, congenital anomalies (aplasia cutis, vascular malformations, and nevus), inflammation, radiation, and chemotherapy.
There are many surgical methods for reconstruction of the scalp e.g primary closure, secondary intention, skin graft, local flaps, distant flaps, and free tissue transfer. Also there are other recent procedures that may be used such as tissue expansion, artificial dermis then skin graft and surgical hair transplantation.
As the type of surgical procedure depends on the size, location and the depth of the defect, Primary closure is suitable for small defects (< 3cm). Secondary intention is useful in patients (smokers, patients who have a history of local radiation) whom condition will interfere with the success of flaps or grafting. Skin graft has a role in temporary covering of the defects until healing occurs then definite treatment is done.
Flaps are the most used options when reconstructing the scalp. They are classified into: local, distant, and free. Local flaps are more commonly used for reconstruction. There are different types of local flaps used e.g single or multiple rotation advancement flaps, VY or H-shaped advancement flaps, transposition flaps, bilobed flaps. They are used for small to moderate-sized defects.
Distant flaps like trapezius muscle and latissimus dorsi muscle flap may be alternative option when large defect (>25 cm2), exists. They can cover large defects especially in the occipital region.
Free tissue transfer offers a one-step solution for resurfacing large scalp defects especially if more than 120 cm2 and produces surprisingly good results, especially in patients with preexisting alopecia. The flaps most commonly used for scalp and forehead reconstruction are the anterolateral thigh (ALT) flap, the latissimus dorsi muscle flap, and the radial forearm flap.
Other data
| Title | Recent and Different Modalities in Reconstruction of Scalp (Anterior Hair Line) | Other Titles | الطرق الحديثة والمختلفة لإعادة بناء فروة الرأس (حد الشعر الأمامى) | Authors | Ahmad Nagy Muhammad | Issue Date | 2014 |
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