Arch Hand Microsurg.  2023 Dec;28(4):287-295. 10.12790/ahm.23.0025.

Reconstruction of extensive scalp defects of oncologic origin using thoracodorsal artery perforator free flaps

• Lee SH
• Lee KT

• KMID: 2548601
• DOI: http://doi.org/10.12790/ahm.23.0025

Abstract

Purpose
Ablation of malignant neoplasms of the scalp usually leaves extensive defects. Free musculocutaneous transfer using the latissimus dorsi muscle with a skin graft has been the gold standard for restoring such defects; however, this approach may be limited by potential functional morbidity and delayed healing of the grafted skin. This study presents a case series of microsurgical reconstruction with thoracodorsal artery perforator (TDAP) flaps for extensive scalp defects after radical oncologic resection.
Methods
Consecutive patients with malignant scalp tumors who underwent wide local excision and defect coverage with TDAP free flaps between April 2019 and January 2023 were evaluated. Operation-related data and surgical outcomes, including donor- and recipient-site complications, postoperative shoulder function, and aesthetic results, were thoroughly assessed. As an oncologic outcome, local recurrence was also recorded.
Results
Eleven patients who underwent reconstruction with an average flap size of 223.2 cm² (range, 160.0–406.0 cm²) were identified. The flaps were based on an average of 2.4 perforators. The donor-site wound was closed primarily in all cases. All flaps achieved complete wound healing within an average of 2 weeks and presented stable resurfacing of the scalp with satisfactory morphological outcomes. No functional shoulder disability was observed in the postoperative period. Five patients exhibited local recurrence but were appropriately treated in a timely manner.
Conclusion
The free TDAP flap could be a potential, effective reconstructive tool for extensive scalp defects of oncologic origin and can overcome the recipient- and donor-site complications associated with the conventional procedure.

Keyword

Scalp; Perforator flap; Free tissue flaps; Microsurgery

Figure

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  Fig. 1. Patient number 5. (A) A final scalp defect measuring 15×11 cm2 is noted following the ablation of a primary angiosarcoma in the subperiosteal layer. (B) A large transverse thoracodorsal artery perforator (TDAP) flap measuring 19.5×13.5 cm2 is designed based on two branches of the thoracodorsal artery. (C) An elevated TDAP flap with a 9-cm-long pedicle. (D) Appearance after the final inset of the TDAP flap with generous dimensions. (E) The donor site is seen to have undergone primary repair.

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  Fig. 2. Patient number 5. Final appearance of the scalp at the 1-year follow-up.

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  Fig. 3. Patient number 5. A linear scar, favorable in terms of aesthetic outcomes, is observed at the donor site.

Reference

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