Abstract
The purpose of this paper is to review the results of free latissimus dorsi transfer for scalp and cranial reconstruction in the case of large defects with exposed brain tissue, cranial bone without periosteal cover, and dura, which cannot be reconstructed with local flaps or skin grafts. Free latissimus dorsi transfer was carried out in seven patients with subtotal and total scalp defects (two reconstruction after tumor removal, two reconstructions after long-standing osteitis, two tissue breakdown after irradiation, one defect reconstruction after high voltage injury). There were three male and four female patients. The age ranged from 36 to 72 years. Reconstruction was performed with a muscle flap (1) or a myocutaneous flap (6) in combination with a split-thickness skin mesh (1:1.5) graft in a single-stage procedure. In a retrospective clinical study, the following criteria were evaluated: (1) flap healing, (2) aesthetic result, and (3) complications. All flaps healed primarily, and all wounds remained closed without any signs of infection. Complete wound healing was achieved after 4 to 8 weeks, depending on the “take” of the skin grafts. Secondary skin grafting was necessary in two patients, while revision of the donor site was necessary in two patients. From an aesthetic point of view, four patients complained about the appearance of the retroauricular skin island. After removal of the skin island 6 months after the initial operation, all patients judged the result as good or acceptable. Besides the free omentum flap, the free latissimus dorsi transfer is the only option for cover of subtotal or total scalp defects. Compared to the omentum flap, the latissimus dorsi offers more tissue, has less donor site morbidity, and secondary surgery such as cranial bone reconstruction is possible. Contrary to most authors, our preferred donor vessels are maxillary artery and the external jugular vein. To avoid any vascular compression, we use a myocutaneous flap. The skin island must be removed secondarily. In patients where no bone reconstruction is possible or planned, the de-epithelialized skin paddle can be used for correction of a contour defect.
References
Haughey BH, Fredrickson JM (1991) The latissimus dorsi donor site. Current use in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 117:1129–1134
Hierner R, Busch K (2004) Kapitel 5: Skalpdefekte. In: Berger A, Hierner R (eds) Plastische Chirurgie, Band II: Kopf und Hals. Springer, Berlin Heidelberg New York, pp 95–123
Maxwell P, Steuber K, Hoopes J (1978) A free latissimus dorsi myocutaneous flap. Plast Reconstr Surg 62:462–466
McClean D, Bunke H (1972) Autotransplant of omentum to a large scalp defect with microsurgical revascularization. Plast Reconstr Surg 49:268–274
McCombe D, Donato R, Hofer SO, Morrison W, Hofer S (2002) Free flaps in the treatment of locally malignancy of the scalp and forehead. Ann Plast Surg 48:600–606
Thomson CJ, Miles DAG, Beveridge J, Chang PS (2004) Treatment of electrical burns by single debridement followed by free-flap coverage: how important is timing. Can J Plast Surg 12:35–36
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Hierner, R., van Loon, J., Goffin, J. et al. Free latissimus dorsi flap transfer for subtotal scalp and cranium defect reconstruction: report of seven cases. Eur J Plast Surg 29, 181–185 (2006). https://doi.org/10.1007/s00238-006-0077-7
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DOI: https://doi.org/10.1007/s00238-006-0077-7