Abstract: Microvascular Composite Reconstruction of the Skull and Scalp: Assessment of Treatment Options
Year: 2017
Type: conference-abstract
Abstract: INTRODUCTION: Microvascular reconstruction of the scalp and skull is difficult for numerous reasons. Composite defects require careful consideration of both soft tissue and bony reconstructive options. The ideal construct would restore the structure of the native scalp and skull, while minimizing the risk of trauma and infection. The optimal way to achieve these goals remains undetermined. METHODS: A retrospective chart review was performed at a tertiary academic medical center for all patients who underwent microvascular surgery of the scalp from July 2011 through December 2016. Reconstructions were evaluated by type of flap utilized (myofascial, myocutaneous, fasciocutaneous, or osteocutaneous) as well as type of cranial reconstruction performed (titanium implant, polyetheretherketone (PEEK) implant, split calvarial graft, or vascularized bone). Fisher’s exact test was used for statistical analysis to compare outcomes between each category of flap and each type of cranial reconstruction. RESULTS: Forty microvascular reconstructions performed in 36 patients were identified during this time. Thirty-two reconstructions included composite scalp and cranial bone or skull base defects. Microvascular flaps used included: myofascial/myocutaneous (n=12), fasciocutaneous (n=10), and osteocutaneous (n=10). No significant differences existed in flap survival or reconstructive outcome based upon type of flap selected for soft tissue coverage. Cranial reconstruction was either autologous (n=15), including vascularized bone grafts (n=10), split calvarial bone grafts (n=4) and banked cranial bone (n=1), or alloplastic (n=13), including titanium (n=6) and PEEK (n=7) cranioplasties. Ten of the 15 (66%) autologous reconstructions and 10 of 13 (77%) alloplastic reconstructions underwent pre-operative radiation. Of the radiated patients, 1 of 10 (10%) autologous reconstructions sustained flap or graft complications. In comparison, flap/implant related complications occurred in 5 of 10 (50%) alloplastic cranioplasties (p=0.05). Alloplastic complications occurred in in 5 of 6 (83.3%) patients reconstructed with titanium implants compared to only 0 of 7 (0%) of PEEK reconstructions (p=0.0006). All reconstructions were salvaged, with 2 of the titanium cranioplasties requiring conversion to PEEK. Only one complication (partial flap loss) occurred in the non-irradiated patients, secondary to post-operative hematoma. CONCLUSION: Composite reconstruction of the skull and scalp is a difficult problem encountered by the microvascular surgeon. In our experience, complete autologous reconstruction is preferable and demonstrated fewer complications than alloplastic reconstruction.
Institution: University of Kansas Medical Center
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W2757631345