Different Surgical Approaches To Scalp Repair And Their Comparisons

Objectives:To summarize and compare the different surgical techniques of scalp repairs, and to discuss the best surgical approaches for scalp defects of different size and depth.Methods:166patients who consulted the department of Burns and Reconstructive Surgery, Xiangya Hospital because of scalp defects from January2002to December2011were reviewed,33of which were injured by avulsion,17by laceration,5by electricity,16by thermal or chemical burns,22defects resulted from benign tumor,47from malignant tumor,4from borderline tumor,22from other causes.85patients received closure by local skin flaps,6by free flaps,43by skin grafts,25by primary closure,13by tissue expansion,5patients received scalp replantation,22received epidural repair with fascia lata. The size of the scalp lesion ranged from1.3cm2to345.58cm, and the depth from subcutaneous tissue to entire thickness of the scalp including calvaria and dura. Comorbidities, duration of hospital stay, post-operative complications, numbers of operation, follow-ups, etc. were identified, and different reconstruction techniques were compared with regard to the duration of hospital stay needed to achieve full wound closure.Results:2free flaps and4replanted scalps failed or partially failed postoperatively, all of which were closed by skin grafts.2cases of local flap had discoloration, and both were recovered after hyberbaric oxygen therapy.5skin grafts partially failed and required further closure. A6-month-to-4-year followup showed15cases of recurrence,12of which required secondary tumor extirpation,1of which required tertiary tumor extirpation,3cases refused further surgical intervention. With regard to the length of hospital stay, local flaps were more effective than skin grafts (P=0.005) in case of injuries involving skin, galea, and pericranium. No significant differences were noted between local flaps and skin grafts in injuries involving skin only.Conclusions:Careful evaluation of the defect as well as the patient's general condition is advised in selecting the best approach to scalp repair. Primary closure is effective in closing small lesions involving scalp only; local flaps and skin grafts are useful to repair medium-sized scalp lesions. In cases of calvaria exposure, local flaps are recommended if the quality of the surrounding tissue is optimal; free flaps are recommended for lesions with inflamed or fibrous border, and for patients who will undergo irradiation therapy post-operatively. Early microvascular reanastamosis can achieve good outcomes for entire scalp avulsion once the patient's vital signs are stablized. Tissue expansion is able to achieve satisfied aesthetic results.