Get access

Successful reconstruction of scalp and skull defects: Lessons learned from a large series§

Authors

  • David C. Shonka Jr. MD,

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
    • Department of Otolaryngology—Head and Neck Surgery, University of Virginia Health System, Box 800713, Charlottesville, VA 22908
    Search for more papers by this author
  • Andrea E. Potash MD,

    1. Department of Otolaryngology—Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
    Search for more papers by this author
  • Mark J. Jameson MD, PhD,

    1. Department of Otolaryngology—Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
    Search for more papers by this author
  • Gerry F. Funk MD

    1. Department of Otolaryngology—Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
    Search for more papers by this author

  • Presented at the Combined Sections Meeting of the Triological Society, Scottsdale, AZ, January 28, 2011.

  • The authors have no financial disclosures for this article.

  • §

    The authors have no conflicts of interest to disclose.

  • Editor's Note: This Manuscript was accepted for publication April 21, 2011.

Abstract

Objective:

To provide a framework for the management of scalp and skull defects.

Design:

Retrospective chart review.

Setting:

Two tertiary care hospitals.

Patients/Intervention:

Fifty-six consecutive patients who underwent reconstruction of scalp and/or skull defects with free flaps, rotational skin/fascia flaps, skin grafts, and implants. Defects closed primarily and those of the lateral temporal bone and skull base were excluded.

Results:

Sixty-two reconstructions were performed. Treatment of skin cancers and intracranial tumors necessitated 31 (50%) and 22 (35%) of the reconstructions, respectively. Defects included partial-thickness soft tissue (9, 15%), full-thickness soft tissue (28, 45%), full-thickness soft tissue and skull (17, 27%), and full-thickness soft tissue, skull, and dura (8, 13%). Radiation or prereconstruction wound breakdown or infection was involved in 33 (53%) and 25 (40%) of cases, respectively. The most common method of reconstruction was free tissue transfer (27, 44%) followed by local skin (15, 24%) or fascia (9, 15%) flaps. There was a 15% (9/62) complication rate; 89% (8/9) of these occurred in radiated tissues and 44% (4/9) occurred in smokers. Seven of the nine patients with complications (78%) were managed with local wound care and/or removal of an implant, whereas 2 (22%) required a second reconstructive procedure. All patients ultimately achieved a safe outcome with no infection and no bone or dural exposure.

Conclusions:

In addition to defect location and extent, availability of surrounding tissue and wound healing characteristics direct reconstruction. Patients who receive radiation therapy are at increased risk of complications. Use of vascularized tissue is critical for successful management, making local flaps and free tissue transfer the mainstay of reconstruction. Laryngoscope, 121:2305-2312, 2011

Ancillary