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Reconstruction of scalp wounds with exposed calvarium using a local flap and a split-thickness skin graft: case series of 20 patients.

AbstractOBJECTIVES:
To describe the design, execution, outcomes, and advantages of a combined flap and split-thickness skin graft reconstructive technique for the repair of wounds of the scalp with exposed bone after Mohs micrographic surgery.
MATERIALS AND METHODS:
An analysis of the combined flap and graft technique of 20 scalp defects ranging in size from 6.25 to 37.6 cm(2) is provided. Surgical defects and patient characteristics are described. Follow-up information is reviewed, and complications and final aesthetic results are reported.
RESULTS:
Twenty patients with 20 tumors on the scalp (16 squamous cell carcinoma, 2 basal cell carcinoma, 1 Merkel cell carcinoma, and 1 malignant fibrous histiocytoma) were treated using Mohs micrographic surgery. A combined flap and graft technique was successfully employed with good aesthetic outcomes in all 20 patients with broad scalp defects. One postoperative complication of approximately 20% skin graft necrosis was noted. One methicillin-resistant Staphylococcus aureus postoperative wound infection occurred but resolved without sequelae with appropriate antibiotic treatment.
CONCLUSION:
The described flap and graft reconstructive technique is a reproducible, one-stage procedure for the reconstruction of medium to large scalp defects with exposed bone, obviating the need for more-complicated, costly, time-consuming procedures.
LIMITATIONS:
Small sample size, descriptive study.
AuthorsBishr Aldabagh, Jonathan L Cook
JournalDermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] (Dermatol Surg) Vol. 40 Issue 3 Pg. 257-65 (Mar 2014) ISSN: 1524-4725 [Electronic] United States
PMID24438208 (Publication Type: Journal Article)
Copyright© 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.
Topics
  • Aged
  • Aged, 80 and over
  • Carcinoma, Basal Cell (pathology, surgery)
  • Carcinoma, Merkel Cell (pathology, surgery)
  • Carcinoma, Squamous Cell (pathology, surgery)
  • Female
  • Histiocytoma, Malignant Fibrous (pathology, surgery)
  • Humans
  • Male
  • Middle Aged
  • Mohs Surgery
  • Plastic Surgery Procedures (methods)
  • Retrospective Studies
  • Scalp (pathology, surgery)
  • Skin Neoplasms (pathology, surgery)
  • Skin Transplantation (methods)
  • Surgical Flaps
  • Treatment Outcome

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