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The Utility of the Galea in scalp reconstruction

Modern Plastic Surgery 2023年第1期13卷 16-22页

作者： Jack D. Sudduth John M. Sullivan Marc E. Walker Division of Plastic and Reconstructive Surgery Department of Surgery University of Mississippi Medical Center Jackson MS USA

Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, treatments evolved to scalp replantation, becoming the standard of care in scalp reconstruction. Although the integrity of the scalp’s blood vessels is pivotal for successful replantation, the authors believe that scalp replantation should be considered at all costs. In the presented case, a 54-year-old female presented to the emergency room following an incident with an auger that completely avulsed her scalp. She was taken back to the operating room, where scalp replantation was performed. Following replantation, scalp necrosis led to serial debridings in the operating room, and eventually, all of the scalp was debrided down to healthy tissue. Surprisingly, the galea survived despite this, which provided a healthy base for skin grafts. Before definitive coverage was placed, it was decided to utilize a bilaminar acellular dermal matrix along with negative pressure wound therapy to create a more robust bed of granulation tissue. After three weeks of this treatment plan, the patient returned to the operating room, where a healthy, viable bed of granulating tissue was revealed beneath the dermal matrix. Split-thickness skin grafts were taken from her thighs bilaterally and sewn together in a quilt-like fashion to cover the wound bed. The entirety of the graft healed without complication except for one small area that required full-thickness skin grafting in an outpatient setting. Even though the replantation ultimately failed, it allowed the galea to survive, which saved the patient from undergoing a free tissue transfer and allowed her scalp to be reconstructed with split-thickness skin grafts. Even in the setting of polytrauma, the authors hope that anyone treating a scalp avulsion would consider scalp replantation at all costs.

关键词： scalp reconstruction scalp Replantation Failed Replantation Galea Polytrauma Split-Thickness Skin Grafts Bilaminar Acellular Dermal Matrix

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Use of the O-Z flap as an alternative to free tissue transfer for reconstruction of large scalp defects

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第4期8卷 355-360页

作者： Austin C.Cao Ryan M.Carey Mitali Shah Kevin Chorath Robert M.Brody Steven B.Cannady Jason G.Newman Rabie M.Shanti Karthik Rajasekaran Perelman School of Medicine University of PennsylvaniaPhiladelphia19104PA Department of Otorhinolaryngology-Head and Neck Surgery University of PennsylvaniaPhiladelphia19104PA Drexel University College of Medicine Drexel UniversityPhiladelphia19102PA Department of Oral and Maxillofacial Surgery University of PennsylvaniaPhiladelphia19104PA Leonard Davis Institute of Health Economics University of PennsylvaniaPhiladelphiaPA

Objective:The reconstruction of large scalp defects poses both functional and cosmetic *** free tissue transfer remains the standard for defects larger than 30 cm^(2),prolonged anesthesia and postoperative complications remain significant *** purpose of this study is to evaluate the use of O-Z flaps for the reconstruction of large scalp defects and to describe the techniques ***:This is a retrospective analysis of ten patients who underwent reconstructive surgery using an O-Z flap approach for large scalp defects between July 2017 and June *** parameters included in this study were patient demographics,tumor characteristics,and postoperative management,collected for at least a year after ***:In this cohort,the mean age was 76.1 years and 90%were *** patients were treated for neoplastic skin lesions,with 70%located on the vertex and 30%located on the temporoparietal *** mean size of defect was 52.0 cm^(2)(range:38.6 to 63.8 cm^(2)).The maximum hospital stay was two days,and no patients were readmitted within 30 days of *** were no cases of wound infection or flap *** patients reported pain control with acetaminophen and *** patients received adjuvant radiation,and there was no delay to receiving treatment following ***:The O-Z flap is a reliable alternative for the reconstruction of non-irradiated scalp defects in the vertex and temporoparietal regions up to 63 cm^(2).This technique provides advantages for patients,including hairline preservation,shorter hospital stays,and decreased postoperative complications.

关键词： scalp reconstruction Local flaps Free flap reconstruction Facial plastics Microvascular surgery Head and neck cancer

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scalp reconstructive flaps

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Plastic and Aesthetic Research 2022年第1期9卷 420-433页

作者： Craig Cameron Brawley Douglas Sidle Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of MedicineChicagoIL 60611USA

scalp reconstruction requires keen insight into underlying anatomy and surgical *** reconstructive surgeon must consider a plethora of complexities to devise a safe and cosmetically maximized *** purpose of this article is to review scalp reconstruction techniques and the current literature in the framework of the reconstructive ladder,with special emphasis on local flap consideration,design,and execution.

关键词： scalp reconstruction scalp defects local flaps scalp flaps reconstructive ladder

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