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Skalp Defektlerinin Serbest Flepler ile Rekonstrüksiyonu

Year 2023, Volume: 62 Issue: 4, 515 - 521, 18.12.2023
https://doi.org/10.19161/etd.1215279

Abstract

Amaç: Skalp; kalvaryal kemiklerin üzerini örtmesi ve saç içermesi gibi önemli görevlere sahiptir. Fonksiyonel ve estetik önemi nedeniyle skalp rekonstrüksiyonu plastik cerrahların sıklıkla ilgilendiği özel bir konu haline gelmiştir. Serbest flepler skalp rekonstrüksiyonu için uzun zamandır güvenli bir şekilde kullanılmasına rağmen ideal flep konusunda literatürde bir fikir birliğine ulaşılamamıştır. Çalışmamızda skalp rekonstrüksiyonlarındaki serbest flep tecrübelerimizi sunmayı amaçladık.
Gereç ve Yöntem: 2018-2021 yılları arasında toplam 7 hastada (3 kadın, 4 erkek ) 8 serbest flep ile skalp rekonstrüksiyonu uygulandı. Hastaların yaşları 8 – 73 arasındaydı. Serbest flep tercihlerimiz arasında 4 latissimus dorsi flebi, 3 anterolateral uyluk flebi ve 1 vertikal rektus abdominis muskulokutan flebi yer almaktaydı. Alıcı damar olarak olarak temporalis süperfisiyalis, temporalis süperfisiyalisin frontal dalı, oksipital damarlar, fasiyal damarlar ve trapezius kasının uygun çapta perforatörü kullanıldı.
Bulgular: Latissimus dorsi serbest flebi yapılan 1 hastada venöz tromboz görüldü. Tüm girişimlere rağmen flep kurtarılamadı. Komplikasyon olarak 1 hastada donör alanda seroma ve 1 hastada alıcı alanda dehisans görüldü. Ek komplikasyon veya flep kaybı gözlenmedi.
Sonuç: Serbest flepler geniş ve/veya kompozit skalp defektlerinde kullanışlı seçeneklerdir. Teknik zorluklarına rağmen, perforatör fleplerin avantajlarından dolayı skalp rekonstrüksiyonunda ilk tercih olabileceğini düşünmekteyiz. Latissimus dorsi flebi, ilk flebin başarısızlığı durumunda kurtarıcı bir alternatif olarak kullanılabilir.
Not: Çalışmamız 18-21 Mayıs 2022 tarihinde Bodrum, Muğla’da gerçekleştirilen 9. Ulusal Rekonstrüktif Mikrocerrahi ve 2. Ulusal Acil El Cerrahisi ve Mikrocerrahi Kongresinde sözlü bildiri olarak sunulmuştur.

References

  • 1. Altınkaya A, Yazar Ş, Sağlam İ, Gideroğlu K. Reconstruction of extensive scalp defects with anterolateral thigh flap. Ulusal Travma ve Acil Cerrahi Dergisi. 2018 Jul 1;24(4):364–8.
  • 2. Mehrara BJ, Disa JJ, Pusic A. Scalp reconstruction. Vol. 94, Journal of Surgical Oncology. 2006. p. 504–8.
  • 3. de La Cruz Monroy MFI, Kalaskar DM, Rauf KG. Tissue expansion reconstruction of head and neck burn injuries in paediatric patients — A systematic review. JPRAS Open. 2018 Dec;18:78–97.
  • 4. Lamaris GA, Knackstedt R, Couto RA, Abedi N, Durand P, Gastman B. The Anterolateral Thigh Flap as the Flap of Choice for Scalp Reconstruction. Journal of Craniofacial Surgery. 2017 Mar;28(2):472–6.
  • 5. Xiao Y, Xiao H, Wan H, Zeng Q, Zhang Y, Xu X. Pre-Expanded Latissimus Dorsi Myocutaneous Flap for Total Scalp Defect Reconstruction. Journal of Craniofacial Surgery. 2020;31(2):e151–3.
  • 6. Uzun H, Bitik O, Ersoy US, Bilginer B, Aksu AE. Comparison of musculocutaneous and fasciocutaneous free flaps for the reconstruction of the extensive composite scalp and cranium defects. Journal of Craniofacial Surgery. 2018;29(7):1947–51.
  • 7. Steiner D, Hubertus A, Arkudas A, Taeger CD, Ludolph I, Boos AM, et al. Scalp reconstruction: A 10-year retrospective study. Journal of Cranio-Maxillofacial Surgery. 2017 Feb 1;45(2):319–24.
  • 8. Kim SW, Hwang KT, Kim J do, Kim YH. Reconstruction of postinfected scalp defects using latissimus dorsi perforator and myocutaneous free flaps. Journal of Craniofacial Surgery. 2012 Nov;23(6):1615–9.
  • 9. Goertz O, von der Lohe L, Martinez-Olivera R, Daigeler A, Harati K, Hirsch T, et al. Microsurgical Reconstruction of Extensive Oncological Scalp Defects. Vol. 2, Frontiers in Surgery. Frontiers Media S.A.; 2015.
  • 10. Gur E, Tiftikcioglu YO, Ozturk K, Yegin ME, Kuybulu TF, Durukan K. Comparison of Current Free Flap Options for Intraoral Lining and Tongue Reconstruction. Journal of Craniofacial Surgery. 2022 Oct;33(7):2240–6.
  • 11. Othman S, Azoury SC, Tecce MG, Shakir S, Rios-Diaz AJ, Mauch JT, et al. Free Flap Reconstruction of Complex Oncologic Scalp Defects in the Setting of Mesh Cranioplasty: Risk Factors and Outcomes. J Craniofac Surg. 2020 Jun 1;31(4):1107–10.
  • 12. Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg. 1993 Sep;92(3):421–8; discussion 429-30.
  • 13. del Castillo Pardo de Vera JL, Navarro Cuéllar C, Navarro Cuéllar I, Cebrián Carretero JL, Bacián Martínez S, García-Hidalgo Alonso MI, et al. Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps. J Clin Med. 2021 Aug 27;10(17):3863.
  • 14. Innocenti A, Menichini G, Innocenti M. Six-years experience in major scalp defect reconstruction with free flap: analysis of the results. Acta Biomed. 2022 Jan 19;92(6):e2021301.
  • 15. Saint-Cyr M, Schaverien M, Wong C, Nagarkar P, Arbique G, Brown S, et al. The Extended Anterolateral Thigh Flap: Anatomical Basis and Clinical Experience. Plast Reconstr Surg. 2009 Apr;123(4):1245–55.
  • 16. Horn D, Jonas R, Engel M, Freier K, Hoffmann J, Freudlsperger C. A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region. Journal of Cranio-Maxillofacial Surgery. 2014 Dec;42(8):1551–6.
  • 17. Gur E. Freestyle anterolateral thigh flap and perforator variations. Turkish Journal of Plastic Surgery. 2022;30:91–5.
  • 18. Oh SJ, Lee J, Cha J, Jeon MK, Koh SH, Chung CH. Free-Flap Reconstruction of the Scalp. Journal of Craniofacial Surgery. 2011 May;22(3):974–7.
  • 19. Vargo JD, Przylecki W, Andrews BT. Surgical decision-making in microvascular reconstruction of composite scalp and skull defects. Vol. 31, Journal of Craniofacial Surgery. Lippincott Williams and Wilkins; 2020. p. 1855–6. 20. Gur E, Tiftikcioglu YO, Ozturk K. Transferring pectoral muscle flap to depleted neck to create a new recipient source for free flaps in head and neck reconstruction. Microsurgery. 2022 Sep 2. doi: 10.1002/micr.30953. Epub ahead of print. PMID: 36052868.

Reconstruction of Scalp Defects with Free Flaps

Year 2023, Volume: 62 Issue: 4, 515 - 521, 18.12.2023
https://doi.org/10.19161/etd.1215279

Abstract

Aim: The scalp has important roles such as containing hair folicles and covering calvarial bones. Due to both aesthetic and functional importance, reconstruction of the scalp becomes special topic that plastic surgeons are frequently interested in. Although free flaps have been used safely in scalp reconstruction for a long time, there is no consensus in the literature on the ideal flap. We aimed to present our free flap experience in scalp defects.
Materials and Methods: Between 2018 and 2021, 8 free flaps were used for scalp reconstruction in 7 patients (3 female, 4 male). The ages of the patients ranged from 8 to 73. The flap choices included 4 latissimus dorsi free flaps, 3 anterolateral thigh flaps and 1 vertical rectus abdominis musculocutaneous flap. Temporalis superficialis, frontal branch of temporalis superficialis, occipital, facial vessels and a perforator of the appropriate diameter of the trapezius muscle were used as recipient.
Results: Venous thrombosis was seen in 1 latissimus dorsi flap. Despite of all attempts the flap could not be salvaged. 1 Seroma and 1 wound dehiscence occurred in different patients as complication. No additional complications or flap loss were experienced.
Conclusion: Free flaps are useful options for large and/or composite defects of the scalp. Despite of technical difficulty, we think that the perforator flaps can be a first choice for scalp reconstructions due to their advantages. So, the latissimus dorsi flap can be used as a second life-boat alternative in the possibility of the flap failure of the first flap.

References

  • 1. Altınkaya A, Yazar Ş, Sağlam İ, Gideroğlu K. Reconstruction of extensive scalp defects with anterolateral thigh flap. Ulusal Travma ve Acil Cerrahi Dergisi. 2018 Jul 1;24(4):364–8.
  • 2. Mehrara BJ, Disa JJ, Pusic A. Scalp reconstruction. Vol. 94, Journal of Surgical Oncology. 2006. p. 504–8.
  • 3. de La Cruz Monroy MFI, Kalaskar DM, Rauf KG. Tissue expansion reconstruction of head and neck burn injuries in paediatric patients — A systematic review. JPRAS Open. 2018 Dec;18:78–97.
  • 4. Lamaris GA, Knackstedt R, Couto RA, Abedi N, Durand P, Gastman B. The Anterolateral Thigh Flap as the Flap of Choice for Scalp Reconstruction. Journal of Craniofacial Surgery. 2017 Mar;28(2):472–6.
  • 5. Xiao Y, Xiao H, Wan H, Zeng Q, Zhang Y, Xu X. Pre-Expanded Latissimus Dorsi Myocutaneous Flap for Total Scalp Defect Reconstruction. Journal of Craniofacial Surgery. 2020;31(2):e151–3.
  • 6. Uzun H, Bitik O, Ersoy US, Bilginer B, Aksu AE. Comparison of musculocutaneous and fasciocutaneous free flaps for the reconstruction of the extensive composite scalp and cranium defects. Journal of Craniofacial Surgery. 2018;29(7):1947–51.
  • 7. Steiner D, Hubertus A, Arkudas A, Taeger CD, Ludolph I, Boos AM, et al. Scalp reconstruction: A 10-year retrospective study. Journal of Cranio-Maxillofacial Surgery. 2017 Feb 1;45(2):319–24.
  • 8. Kim SW, Hwang KT, Kim J do, Kim YH. Reconstruction of postinfected scalp defects using latissimus dorsi perforator and myocutaneous free flaps. Journal of Craniofacial Surgery. 2012 Nov;23(6):1615–9.
  • 9. Goertz O, von der Lohe L, Martinez-Olivera R, Daigeler A, Harati K, Hirsch T, et al. Microsurgical Reconstruction of Extensive Oncological Scalp Defects. Vol. 2, Frontiers in Surgery. Frontiers Media S.A.; 2015.
  • 10. Gur E, Tiftikcioglu YO, Ozturk K, Yegin ME, Kuybulu TF, Durukan K. Comparison of Current Free Flap Options for Intraoral Lining and Tongue Reconstruction. Journal of Craniofacial Surgery. 2022 Oct;33(7):2240–6.
  • 11. Othman S, Azoury SC, Tecce MG, Shakir S, Rios-Diaz AJ, Mauch JT, et al. Free Flap Reconstruction of Complex Oncologic Scalp Defects in the Setting of Mesh Cranioplasty: Risk Factors and Outcomes. J Craniofac Surg. 2020 Jun 1;31(4):1107–10.
  • 12. Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg. 1993 Sep;92(3):421–8; discussion 429-30.
  • 13. del Castillo Pardo de Vera JL, Navarro Cuéllar C, Navarro Cuéllar I, Cebrián Carretero JL, Bacián Martínez S, García-Hidalgo Alonso MI, et al. Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps. J Clin Med. 2021 Aug 27;10(17):3863.
  • 14. Innocenti A, Menichini G, Innocenti M. Six-years experience in major scalp defect reconstruction with free flap: analysis of the results. Acta Biomed. 2022 Jan 19;92(6):e2021301.
  • 15. Saint-Cyr M, Schaverien M, Wong C, Nagarkar P, Arbique G, Brown S, et al. The Extended Anterolateral Thigh Flap: Anatomical Basis and Clinical Experience. Plast Reconstr Surg. 2009 Apr;123(4):1245–55.
  • 16. Horn D, Jonas R, Engel M, Freier K, Hoffmann J, Freudlsperger C. A comparison of free anterolateral thigh and latissimus dorsi flaps in soft tissue reconstruction of extensive defects in the head and neck region. Journal of Cranio-Maxillofacial Surgery. 2014 Dec;42(8):1551–6.
  • 17. Gur E. Freestyle anterolateral thigh flap and perforator variations. Turkish Journal of Plastic Surgery. 2022;30:91–5.
  • 18. Oh SJ, Lee J, Cha J, Jeon MK, Koh SH, Chung CH. Free-Flap Reconstruction of the Scalp. Journal of Craniofacial Surgery. 2011 May;22(3):974–7.
  • 19. Vargo JD, Przylecki W, Andrews BT. Surgical decision-making in microvascular reconstruction of composite scalp and skull defects. Vol. 31, Journal of Craniofacial Surgery. Lippincott Williams and Wilkins; 2020. p. 1855–6. 20. Gur E, Tiftikcioglu YO, Ozturk K. Transferring pectoral muscle flap to depleted neck to create a new recipient source for free flaps in head and neck reconstruction. Microsurgery. 2022 Sep 2. doi: 10.1002/micr.30953. Epub ahead of print. PMID: 36052868.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Articles
Authors

Ersin GUR 0000-0003-4776-1934

Turgut Furkan KUYBULU 0000-0003-4309-6420

Hamit Hakan BEKİR 0000-0002-2331-6548

Nargiz İBRAHİMLİ 0000-0002-0767-8717

Mehmet Emre YEĞİN 0000-0001-5788-0705

Gizem Şule ATEŞ 0000-0001-6445-1669

Yiğit Özer TİFTİKCİOĞLU 0000-0002-9930-5802

Publication Date December 18, 2023
Submission Date December 6, 2022
Published in Issue Year 2023Volume: 62 Issue: 4

Cite

Vancouver GUR E, KUYBULU TF, BEKİR HH, İBRAHİMLİ N, YEĞİN ME, ATEŞ GŞ, TİFTİKCİOĞLU YÖ. Skalp Defektlerinin Serbest Flepler ile Rekonstrüksiyonu. EJM. 2023;62(4):515-21.