J Korean Cleft Palate-Craniofac Assoc.  2011 Oct;12(2):107-110.

Reconstruction of Long Term Neglected, Complicated Scalp and Calvarial Defects with Subdural Abscess Using Latissimus Dorsi Myocutaneous Free Flap: A Case Report

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea.
  • 3Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Medical Center, Seoul, Korea. alfbskan@gmail.com

Abstract

PURPOSE
There have been few case reports regarding treatment plans for long-term, neglected scalp defects and calvarial defects with subdural abscess. The purpose of this case report is to present our experience with a free latissimus dorsi musculocutaneous flap for scalp and calvarial defects and to discuss flap options in comparison with a literature review.
METHODS
A 60-year-old man who fell down from a four-story-height that resulted in a craniotomy in 1979; he visited our outpatient clinic for a chronic, purulent scalp and calvarial defects with unidentified artificial bone. The artificial bone was removed by a neurosurgeon and reconstructed with a free latissimus dorsi musculocutaneous flap. The deep temporal artery was used as a recipient artery. The postoperative flap status was excellent until the 6th day post-operation when the patient experienced a seizure, and an arterial insufficiency occurred at the flap probably due to an arterial spasm. Emergency exploration with arterial re-anastomosis was performed and the flap status was stabilized.
RESULTS
Complete wound healing was achieved after 3 weeks without infectious and systemic postoperative complications. During the 6 month follow-up period, there were no complications.
CONCLUSION
We suggest the latissimus dorsi myocutaneous free flap as a good treatment option for a chronic, purulent, complicated scalp with calvarial defect, as a well as treatment for an acute traumatic defect.

Keyword

Calvarial defect; Latissimus dorsi myocutaneous free flap

MeSH Terms

Abscess
Ambulatory Care Facilities
Arteries
Craniotomy
Emergencies
Follow-Up Studies
Free Tissue Flaps
Humans
Middle Aged
Postoperative Complications
Scalp
Seizures
Spasm
Temporal Arteries
Wound Healing
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