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JAMA Facial Plastic Surgery 2015Reconstruction of the scalp after acquired defects remains a common challenge for the reconstructive surgeon, especially in a patient with a history of radiation to the... (Review)
Review
IMPORTANCE
Reconstruction of the scalp after acquired defects remains a common challenge for the reconstructive surgeon, especially in a patient with a history of radiation to the area.
OBJECTIVE
To review the current literature and describe a novel algorithm to help guide the reconstructive surgeon in determining the optimal reconstruction from a cosmetic and functional standpoint. Pertinent surgical anatomy, considerations for patient and technique selection, reconstructive goals, as well as the reconstructive ladder, are also discussed.
EVIDENCE REVIEW
A PubMed and Medline search was performed of the entire English literature with respect to scalp reconstruction. Priority of review was given to those studies with higher-quality levels of evidence.
FINDINGS
Size, location, radiation history, and potential for hairline distortion are important factors in determining the ideal reconstruction. The tighter and looser areas of the scalp play a major role in the potential for primary or local flap closure. Patients with medium to large defects and a history of radiation will likely benefit from free tissue transfer.
CONCLUSIONS AND RELEVANCE
Ideal reconstruction of scalp defects relies on a comprehensive understanding of scalp anatomy, a full consideration of the armamentarium of surgical techniques, and a detailed appraisal of patient factors and expectations. The simplest reconstruction should be used whenever possible to provide the most functional and aesthetic scalp reconstruction, with the least amount of complexity.
LEVEL OF EVIDENCE
NA.
Topics: Algorithms; Esthetics; Female; Free Tissue Flaps; Graft Rejection; Graft Survival; Humans; Male; Negative-Pressure Wound Therapy; Plastic Surgery Procedures; Scalp; Skin Transplantation; Tissue Expansion; Tissue Expansion Devices; Wound Healing; Wounds and Injuries
PubMed: 25375669
DOI: 10.1001/jamafacial.2014.889 -
Facial Plastic Surgery : FPS Aug 2021The primary challenges in scalp reconstruction are the relative inelasticity of native scalp tissue and the convex shape of the calvarium. All rungs of the...
The primary challenges in scalp reconstruction are the relative inelasticity of native scalp tissue and the convex shape of the calvarium. All rungs of the reconstructive ladder can be applied to scalp reconstruction, albeit in a nuanced fashion due to the unique anatomy and vascular supply to the scalp. Important defect variables to incorporate into the reconstructive decision include site, potential hairline distortion, size, depth, concomitant infection, prior radiation therapy, planned adjuvant therapy, medical comorbidities, patient desires, and potential calvarium and dura defects.
Topics: Forehead; Humans; Plastic Surgery Procedures; Scalp; Skin Neoplasms; Surgical Flaps
PubMed: 33580493
DOI: 10.1055/s-0041-1722914 -
Indian Journal of Dermatology,... 2016
Topics: Adult; Humans; Male; Meningeal Neoplasms; Meningioma; Scalp; Skin Neoplasms; Tomography, X-Ray Computed
PubMed: 26765130
DOI: 10.4103/0378-6323.173592 -
Rheumatology (Oxford, England) May 2024
Topics: Humans; Scalp; Scalp Dermatoses; Skin Ulcer
PubMed: 37897698
DOI: 10.1093/rheumatology/kead573 -
Anticancer Research Mar 2018Angiosarcoma, a rare cutaneous malignancy, frequently arises in the scalp of older individuals. Because it characteristically initially mimics benign disease, such as a... (Review)
Review
Angiosarcoma, a rare cutaneous malignancy, frequently arises in the scalp of older individuals. Because it characteristically initially mimics benign disease, such as a bruise, definitive diagnosis in the early stages is difficult. Angiosarcoma of the scalp is highly malignant and often accompanied by lung metastases that cause hemopneumothorax. Although surgery has been the standard and most reliable curative treatment for angiosarcoma of the scalp, there is a high probability of local recurrence, even after wide surgical excision. Therefore, postoperative radiation therapy has been administered in an attempt to minimize local recurrence. However, surgery is contraindicated in many older patients because of severe comorbidities or age. Definitive radiation therapy has been administered to such patients and has achieved good local control. In particular, total scalp irradiation may be a promising option for curative treatment of angiosarcoma of the scalp. Recent reports suggest that chemotherapy, particularly with taxanes, can prolong survival by reducing the rate of distant failure after radiation therapy. Thus, radiation therapy along with chemotherapy is now recommended for curative treatment of patients with inoperable disease and even some patients with operable disease. Technological developments in radiation therapy, such as intensity-modulated radiation therapy, will contribute to enhanced efficacy and reduced toxicities in the treatment of patients with angiosarcoma of the scalp.
Topics: Head and Neck Neoplasms; Hemangiosarcoma; Humans; Radiotherapy, Intensity-Modulated; Scalp; Skin Neoplasms; Treatment Outcome
PubMed: 29491047
DOI: 10.21873/anticanres.12346 -
Revista Da Associacao Medica Brasileira... Dec 2016Arteriovenous malformations (AVMs) of the scalp are rare lesions. The clinical picture presents with complaints of increased scalp, scalp disfigurement, pain and...
Arteriovenous malformations (AVMs) of the scalp are rare lesions. The clinical picture presents with complaints of increased scalp, scalp disfigurement, pain and neurological symptoms. Its origin can be congenital or traumatic. We present a case of giant scalp AVMs and its management, followed by a brief literature review on the subject. The diagnosis of scalp AVMs is based on physical examination and confirmed by internal and external carotid angiography or computed tomographic angiography (CTA). Surgical excision is especially effective in scalp AVMs, and is the most frequently used treatment modality.
Topics: Adult; Arteriovenous Malformations; Computed Tomography Angiography; Humans; Male; Photography; Scalp
PubMed: 28001255
DOI: 10.1590/1806-9282.62.09.828 -
The Journal of Craniofacial SurgeryScalp avulsions are rare but can be quite morbid clinical manifestations. Pediatric patients are different from adults as they have not completed their physical, sexual,...
Scalp avulsions are rare but can be quite morbid clinical manifestations. Pediatric patients are different from adults as they have not completed their physical, sexual, educational, or psychosocial development. Therefore, the devastation of a failed scalp replantation is much greater on these individuals, their whole future lives, and families. We present 2 consecutive pediatric cases retrospectively with the youngest successful replanted patient in Turkey and describe technical tips according to our experience.
Topics: Adult; Humans; Child; Scalp; Retrospective Studies; Microsurgery; Anastomosis, Surgical; Amputation, Traumatic
PubMed: 35894477
DOI: 10.1097/SCS.0000000000008860 -
Acta Dermato-venereologica Mar 2023Scalp psoriatic itch is a common, bothersome, yet understudied, condition with numerous associated treatment challenges. The aim of this study was to enhance our...
Scalp psoriatic itch is a common, bothersome, yet understudied, condition with numerous associated treatment challenges. The aim of this study was to enhance our understanding of the pathophysiology of scalp psoriatic itch. Immunohistochemical analysis of known neuroimmune mediators of pruritus was conducted using scalp biopsies from 27 Hispanic psoriatic patients. Patients were categorized into mild/moderate or severe itch groups according to their itch intensity rating of scalp itch. Protease activated receptor (PAR2), substance P, transient receptor potential (TRP)V3, TRPM8 and interleukin-23 expression all correlated significantly with itch intensity. The pathophysiology of scalp psoriasis is largely non-histaminergic, mediated by PAR2, interleukin-23, transient receptor potential channels, and substance P.
Topics: Humans; Scalp; Substance P; Pruritus; Psoriasis; Hispanic or Latino
PubMed: 36967545
DOI: 10.2340/actadv.v103.4463 -
The British Journal of Dermatology Sep 2017
Topics: Aged; Alopecia; Female; Fibrosis; Hair Preparations; Humans; Laser Therapy; Lichen Planus; Male; Scalp; Treatment Outcome
PubMed: 28052312
DOI: 10.1111/bjd.15273 -
Plastic and Reconstructive Surgery Sep 2022Electrical injuries of the scalp are a frequent occurrence in developing countries. Burns can be contact or conductive and result in extensive tissue damage. The authors...
BACKGROUND
Electrical injuries of the scalp are a frequent occurrence in developing countries. Burns can be contact or conductive and result in extensive tissue damage. The authors present their experience with treatment of scalp and calvarial electrical injuries and propose a management algorithm.
METHODS
This was a retrospective cohort study comprising all patients with electrical injuries of the scalp treated at the authors' center between January of 2010 and December of 2016. Noncontrast computed tomography scans were obtained to assess viability of the calvarium in patients who presented more than 2 weeks after injury. Single-stage débridement and reconstruction were performed. All nonviable soft tissue and bone was removed. Soft-tissue reconstruction was performed with skin grafts, local scalp flaps, pedicled trapezius flaps, and free flaps (anterolateral thigh, latissimus dorsi, and scapular). Cranioplasty was performed in a delayed manner with autologous bone grafts.
RESULTS
Over a 7-year period, a total of 52 patients underwent scalp reconstruction for high-voltage (44 patients) and low-voltage (eight patients) electrical injury. All patients underwent successful soft-tissue reconstruction. Osteomyelitis with draining sinuses developed in three patients; these patients underwent flap re-elevation and bone débridement, which resulted in a healed wound and stable reconstruction. Cranioplasty was performed with split calvarial grafts in two patients and split rib grafts in four patients. One patient underwent scalp tissue expansion for hair restoration.
CONCLUSION
The authors propose an algorithm for reconstruction of electrical injuries of the scalp. Thorough débridement of the calvarium is the most important determinant of a successful outcome.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Algorithms; Free Tissue Flaps; Humans; Plastic Surgery Procedures; Retrospective Studies; Scalp; Skin Transplantation; Soft Tissue Injuries; Treatment Outcome
PubMed: 35791281
DOI: 10.1097/PRS.0000000000009452