Two-stage free flap reconstruction of the scalp and calvaria for large neurosurgical resections.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
07
01
2019
revised:
12
09
2019
accepted:
08
11
2019
pubmed:
30
11
2019
medline:
29
1
2021
entrez:
29
11
2019
Statut:
ppublish
Résumé
Free tissue transfer is occasionally necessary during reconstruction of large scalp and calvarial bone resections. A single-stage procedure is usually performed but if a flap becomes necrotic it exposes brain tissue or the meninges. Performing a two-stage procedure, the surgeon must preserve flap vitality and manage flap complications before resecting a tumor, and therefore before exposing the brain or meninges. We report here the first series of two-stage free-flap reconstruction during major neurosurgical resection. From 2012 to 2018, nine free-flaps were performed to eight patients (61 years-old, on average). Average skull resection was 10.1 cm × 15 cm (range 6-18 cm × 9-24 cm). It was performed in all cases due to large malignant tumors. Resection/reconstruction was performed in all case in a two-step procedure: during the first step, the free-flap was harvested and anastomosed to the cranial site; during the second step, resection was performed and the flap was positioned into the defect to assure coverage. Average flap size was 11.3 cm × 17.7 cm (range: 7-20 cm × 11-30 cm). Two flap complications occurred after the first stage and one flap did not survive. One patient died before the second stage. Seven patients had the second procedure; no flap complication occurred. All procedures ended in complete wound healing. Follow-up period was 41.5 months on average (range: 10-83 months). Final outcome was total remission for two patients, recurrence for four patients, and two patients died. Our data suggest that the two-stage free-flap reconstruction may be employed for major scalp and calvaria resection.
Sections du résumé
BACKGROUND
BACKGROUND
Free tissue transfer is occasionally necessary during reconstruction of large scalp and calvarial bone resections. A single-stage procedure is usually performed but if a flap becomes necrotic it exposes brain tissue or the meninges. Performing a two-stage procedure, the surgeon must preserve flap vitality and manage flap complications before resecting a tumor, and therefore before exposing the brain or meninges. We report here the first series of two-stage free-flap reconstruction during major neurosurgical resection.
METHODS
METHODS
From 2012 to 2018, nine free-flaps were performed to eight patients (61 years-old, on average). Average skull resection was 10.1 cm × 15 cm (range 6-18 cm × 9-24 cm). It was performed in all cases due to large malignant tumors. Resection/reconstruction was performed in all case in a two-step procedure: during the first step, the free-flap was harvested and anastomosed to the cranial site; during the second step, resection was performed and the flap was positioned into the defect to assure coverage.
RESULTS
RESULTS
Average flap size was 11.3 cm × 17.7 cm (range: 7-20 cm × 11-30 cm). Two flap complications occurred after the first stage and one flap did not survive. One patient died before the second stage. Seven patients had the second procedure; no flap complication occurred. All procedures ended in complete wound healing. Follow-up period was 41.5 months on average (range: 10-83 months). Final outcome was total remission for two patients, recurrence for four patients, and two patients died.
CONCLUSIONS
CONCLUSIONS
Our data suggest that the two-stage free-flap reconstruction may be employed for major scalp and calvaria resection.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
331-336Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Afifi, A., Djohan, R. S., Hammert, W., Papay, F. A., Barnett, A. E., & Zins, J. E. (2010). Lessons learned reconstructing complex scalp defects using free flaps and a cranioplasty in one stage. The Journal of Craniofacial Surgery, 21(4), 1205-1209.
Chang, K. P., Lai, C. H., Chang, C. H., Lin, C. L., Lai, C. S., & Lin, S. D. (2010). Free flap options for reconstruction of complicated scalp and calvarial defects: Report of a series of cases and literature review. Microsurgery, 30(1), 13-18.
Cho, G. J., Wang, F., Garcia, S. M., Viner, J., Hoffman, W. Y., McDermott, M. W., & Pomerantz, J. H. (2017). Recalcitrant invasive skin cancer of the scalp: Combined extirpation and microsurgical reconstruction without cranioplasty. The Journal of Craniofacial Surgery, 28(2), 325-330.
Goertz, O., Von der Lohe, L., Martinez-Olivera, R., Daigeler, A., Harati, K., Hirsch, T., … Kolbenschlag, J. (2015). Microsurgical reconstruction of extensive oncological scalp defects. Frontiers in Surgery, 2, 44.
Goldstein, J. A., Paliga, J. T., & Bartlett, S. P. (2013). Cranioplasty: Indications and advances. Current Opinion in Otolaryngology & Head and Neck Surgery, 21(4), 400-409.
Hierner, R., van Loon, J., Goffin, J., & van Calenbergh, F. (2007). Free latissimus dorsi flap transfer for subtotal scalp and cranium defect reconstruction: Report of 7 cases. Microsurgery, 27(5), 425-428.
Khoury, R., Cooley, B., Kunselman, A., Landis, J. R., Yeramian, P., Ingram, D., … Wallemark, C. (1998). A prospective study of microvascular free-flap surgery and outcome. Plastic and Reconstructive Surgery, 102(3), 711-721.
Kwarcinski, J., Boughton, P., Ruys, A., Doolan, A., & van Gelder, J. (2017). Cranioplasty and craniofacial reconstruction: A review of implant material, manufacturing method and infection risk. Applied Sciences, 7, 276.
Mehrara, B. J., Disa, J. J., & Pusic, A. (2006). Scalp reconstruction. Journal of Surgical Oncology, 94(6), 504-508.
O'Connell, D. A., Teng, M. S., Mendez, E., & Futran, N. D. (2011). Microvascular free tissue transfer in the reconstruction of scalp and lateral temporal bone defects. Journal of Craniofacial Surgery, 22(3), 801-804.
Oh, S. J., Lee, J., Cha, J., Jeon, M. K., Koh, S. H., & Chung, C. H. (2011). Free-flap reconstruction of the scalp: Donor selection and outcome. The Journal of Craniofacial Surgery, 22(3), 974-977.
Philandrianos, C., Casanova, D., D'journo, X.-B., & Thomas, P. A. (2016). Two-stage free anterolateral thigh flap in the management of full-thickness chest wall resection. European Journal of Cardio-Thoracic Surgery, 50, 1208-1209.
Scaglioni, M. F., & Giunta, G. (2019). Reconstruction of cranioplasty using the thoracodorsal artery perforator (TDAP) flap: A case series. Microsurgery, 39(3), 207-214.
Servant, J.-M., Arnault, E., Revol, M., & Danino, A. (2006). Reconstruction of large thoracoabdominal defects using two-stage free tissue transfers and prosthetic materials. Plastic and Reconstructive Surgery, 59, 360-365.
Shonka, D. C., Potash, A. E., Jameson, M. J., & Funk, G. F. (2011). Successful reconstruction of scalp and skull defects: Lessons learned from a large series. The Laryngoscope, 121(11), 2305-2312.
Van Driel, A. A., Mureau, M. A., Goldstein, D. P., Gilbert, R. W., Irish, J. C., Gullane, P. J., … Hofer, S. O. (2010). Aesthetic and oncologic outcomes after microsurgical reconstruction of complex scalp and fore-head defects after malignant tumor resection: An algorithm for treatment. Plastic and Reconstructive Surgery, 126, 460-470.
Wang, H. T., Erdmann, D., Olbrich, K. C., Friedman, A. H., Levin, L. S., & Zenn, M. R. (2007). Free flap reconstruction of the scalp and calvaria of major neurosurgical resections in cancer patients: Lessons learned closing large, difficult wounds of the dura and skull. Plastic and Reconstructive Surgery, 119(3), 865-872.
Yoshioka, N. (2017). Versatility of the latissimus dorsi free flap during the treatment of complex postcraniotomy surgical site infections. Plastic and Reconstructive Surgery. Global Open, 5(6), e1355.