An Algorithm Of Malignent Oncologic Scalp Reconstruction

ObjectiveTo select appropriate reconstrctive methods according to the surgical defects of scalp malignant tumors.MethodsWe performed a retrospective analysis of clinnical data of 173 patients who accepted surgery for scalp malignent tumor in the Department of Head and Neck,Sichuan Cancer Hospital.Data regarding tumor type and nature;scalp defect location,size and depth;reconstructive procedure and complications were collected and analyzed retrospectively.The findings extracted from the data were amalgamated to produce the proposed reconstructive algorithm for scalp defect size and depth.ResultsAmong primary scalp malignent tumors,small defects could be closed by primary closure.Medium defects were given priority to local flaps.Skin graft was usually used to reconstruct large defect.And the defect location did not have an impact on the algorithm of above three types of defects.Extra large defects in frontal,temperol and vetex areas should be reconstructed by free flaps while the pedicle flaps suited for occipital defects.The reconstruction algorithm of recurrent tumor was similar to primary tumor's except for the medium defects in occupital area which were mainly recontructed by skin graft.The defects combined with scalp and cranium should be first to reconstructed by free flaps.And pedicle flaps could equal to free flaps for this kind of defect in occupital area.ConclusionReconstruction is the basis of radical surgery resection.Successful reconstruction of scalp requires careful preoperative planning and precise intraoperative excecution.The algorithm based on defect size,depth and type can contribute to choosing rational reconstructive procedure.