Arch Craniofac Surg.  2017 Jun;18(2):112-116. 10.7181/acfs.2017.18.2.112.

Reconstruction of a Complex Scalp Defect after the Failure of Free Flaps: Changing Plans and Strategy

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Korea.
  • 2Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea. sw1215@snu.ac.kr

Abstract

The ideal scalp reconstruction involves closure of the defect with similar hair-bearing local tissue in a single step. Various reconstructions can be used including primary closure, secondary healing, skin grafts, local flaps, and microvascular tissue transfer. A 53-year-old female patient suffered glioblastoma, which had recurred for the second time. The neurosurgeons performed radial debridement and an additional resection of the tumor, followed by reconstruction using a serratus anterior muscle flap with a split-thickness skin graft. Unfortunately, the flap became completely useless and a bilateral rotation flap was used to cover the defect. Two month later, seroma with infection was found due to recurrence of the tumor. Additional surgery was performed using multiple perforator based island flap. The patient was discharged two weeks after surgery without any complications, but two months later, the patient died. Radical surgical resection of tumor is the most important curative option, followed by functional and aesthetic reconstruction. We describe a patient with a highly malignant tumor that required multiple resections and subsequent reconstruction. Repeated recurrences of the tumor led to the failure of reconstruction and our strategy inevitably changed, from reconstruction to palliative treatment involving fast and stable wound closure for the patient's comfort.

Keyword

Perforator flap; Reconstructive surgical procedures; Surgical flaps; Scalp

MeSH Terms

Debridement
Female
Free Tissue Flaps*
Glioblastoma
Humans
Middle Aged
Neurosurgeons
Palliative Care
Perforator Flap
Reconstructive Surgical Procedures
Recurrence
Scalp*
Seroma
Skin
Surgical Flaps
Transplants
Wounds and Injuries
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