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An algorithm for one-stage malignant oncologic scalp reconstruction

BACKGROUND: Scalp reconstruction has always been a challenging problem after oncological resection. Advanced surgical techniques can reconstruct any defects, but there are a large number of patients who cannot benefit from surgery for immature strategies. The authors here describe an algorithm for s...

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Autores principales: Zhou, Yuqiu, Jiang, Zhenhua, Li, Chao, Cai, Yongcong, Sun, Ronghao, Shui, Chunyan, An, Changming, Tang, Zhengqi, Sheng, Jianfeng, Liu, Dingrong, Zeng, Dingfen, Jiang, Jian, Zhu, Guiquan, Wang, Shaoxin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210181/
https://www.ncbi.nlm.nih.gov/pubmed/32395476
http://dx.doi.org/10.21037/atm.2020.03.221
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author Zhou, Yuqiu
Jiang, Zhenhua
Li, Chao
Cai, Yongcong
Sun, Ronghao
Shui, Chunyan
An, Changming
Tang, Zhengqi
Sheng, Jianfeng
Liu, Dingrong
Zeng, Dingfen
Jiang, Jian
Zhu, Guiquan
Wang, Shaoxin
author_facet Zhou, Yuqiu
Jiang, Zhenhua
Li, Chao
Cai, Yongcong
Sun, Ronghao
Shui, Chunyan
An, Changming
Tang, Zhengqi
Sheng, Jianfeng
Liu, Dingrong
Zeng, Dingfen
Jiang, Jian
Zhu, Guiquan
Wang, Shaoxin
author_sort Zhou, Yuqiu
collection PubMed
description BACKGROUND: Scalp reconstruction has always been a challenging problem after oncological resection. Advanced surgical techniques can reconstruct any defects, but there are a large number of patients who cannot benefit from surgery for immature strategies. The authors here describe an algorithm for selecting the best reconstructive categories and minimizing complications according to the surgical defect of scalp tumors. METHODS: A single-institution retrospective review was conducted that included 173 patients with scalp tumors treated with surgery followed by reconstruction. Patients were identified by tumor type and nature; the location of scalp defect, size, and depth; the types of reconstructions and surgical. A systematic algorithm was developed according to our findings and current literature. RESULTS: Small defects (≤4 cm(2)) could be closed by primary closure. Medium defects (4–30 cm(2)) were reconstructed by local flaps. We routinely used skin graft for significant surgical defects (30–90 cm(2)). And the tumor’s location did not have an impact on reconstructive categories of above three types of defects. Free flaps should reconstruct very large-sized defects (>90 cm(2)) in frontal, temporal, and vertex locations while pedicle flaps suited for occipital defects due to its anatomic vicinity. The reconstruction algorithm of recurrent disease was like the management in primary tumors except for the medium size defect in the occipital region that was primarily reconstructed by a skin graft. Multiple free flaps reconstruction is the best possibility for total scalp resection. Free flap reconstruction is used mainly for composite resection of the scalp, calvarium, and dura. CONCLUSIONS: Successful scalp reconstruction requires careful preoperative assessment, flexible and precisely intraoperative management. The algorithm based on defect size, depth, and location can supply some degree of guidelines when considering choosing suitable reconstructive procedures.
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spelling pubmed-72101812020-05-11 An algorithm for one-stage malignant oncologic scalp reconstruction Zhou, Yuqiu Jiang, Zhenhua Li, Chao Cai, Yongcong Sun, Ronghao Shui, Chunyan An, Changming Tang, Zhengqi Sheng, Jianfeng Liu, Dingrong Zeng, Dingfen Jiang, Jian Zhu, Guiquan Wang, Shaoxin Ann Transl Med Original Article BACKGROUND: Scalp reconstruction has always been a challenging problem after oncological resection. Advanced surgical techniques can reconstruct any defects, but there are a large number of patients who cannot benefit from surgery for immature strategies. The authors here describe an algorithm for selecting the best reconstructive categories and minimizing complications according to the surgical defect of scalp tumors. METHODS: A single-institution retrospective review was conducted that included 173 patients with scalp tumors treated with surgery followed by reconstruction. Patients were identified by tumor type and nature; the location of scalp defect, size, and depth; the types of reconstructions and surgical. A systematic algorithm was developed according to our findings and current literature. RESULTS: Small defects (≤4 cm(2)) could be closed by primary closure. Medium defects (4–30 cm(2)) were reconstructed by local flaps. We routinely used skin graft for significant surgical defects (30–90 cm(2)). And the tumor’s location did not have an impact on reconstructive categories of above three types of defects. Free flaps should reconstruct very large-sized defects (>90 cm(2)) in frontal, temporal, and vertex locations while pedicle flaps suited for occipital defects due to its anatomic vicinity. The reconstruction algorithm of recurrent disease was like the management in primary tumors except for the medium size defect in the occipital region that was primarily reconstructed by a skin graft. Multiple free flaps reconstruction is the best possibility for total scalp resection. Free flap reconstruction is used mainly for composite resection of the scalp, calvarium, and dura. CONCLUSIONS: Successful scalp reconstruction requires careful preoperative assessment, flexible and precisely intraoperative management. The algorithm based on defect size, depth, and location can supply some degree of guidelines when considering choosing suitable reconstructive procedures. AME Publishing Company 2020-04 /pmc/articles/PMC7210181/ /pubmed/32395476 http://dx.doi.org/10.21037/atm.2020.03.221 Text en 2020 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Zhou, Yuqiu
Jiang, Zhenhua
Li, Chao
Cai, Yongcong
Sun, Ronghao
Shui, Chunyan
An, Changming
Tang, Zhengqi
Sheng, Jianfeng
Liu, Dingrong
Zeng, Dingfen
Jiang, Jian
Zhu, Guiquan
Wang, Shaoxin
An algorithm for one-stage malignant oncologic scalp reconstruction
title An algorithm for one-stage malignant oncologic scalp reconstruction
title_full An algorithm for one-stage malignant oncologic scalp reconstruction
title_fullStr An algorithm for one-stage malignant oncologic scalp reconstruction
title_full_unstemmed An algorithm for one-stage malignant oncologic scalp reconstruction
title_short An algorithm for one-stage malignant oncologic scalp reconstruction
title_sort algorithm for one-stage malignant oncologic scalp reconstruction
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210181/
https://www.ncbi.nlm.nih.gov/pubmed/32395476
http://dx.doi.org/10.21037/atm.2020.03.221
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