Complex scalp defects

Defects of the scalp may result from trauma, tumor resection, infections, congenital lesions and radiation treatment. Large and complex defects extending to bone can represent a significant challenge to the reconstructive head and neck surgeon. We here present our experience in the treatment of complex scalp defects. Material & Methods: We conducted a retrospective study of patients treated for complex defects of the scalp in the Department of Maxillo-Facial and Plastic Surgery in Sahloul Hospital (Sousse-Tunisia). Data studied were: Epidemiological (age, sex), etiologies, characteristics of the defect, surgical procedures and outcomes. Results: A total of 6 male patients have undergone reconstruction for defects in the anterior scalp subunits (forehead=1, fronto-temporal=3, parietal=1, parieto-temporal=1). The average age of patients was 53 years (min 25 years and max 81 years). The scalp defects resulted either from: tumor resection (2 patients); post-traumatic loss of the scalp (3 patients) and; electric burn (1 patient). As a surgical reconstruction; galea-aponeurotic flaps and split-thickness skin grafting were done in 2 cases, a temporal muscular flap was performed in 1 case and a latissimus dorsi free flap was performed in 2 cases. Conclusion: Scalp reconstruction represents a challenge, as the reconstructive surgeon should strive for a cosmetically appealing result as well as for durable coverage to the exposed cranium. Although local flaps have been described for the reconstruction of these defects, free flaps are the preferred choice when a significant area of soft tissue coverage is required or when the defect concerns the bone.

J Bouguila is Assistant Professor at La Rabta University Hospital, Tunisia. He completed Medical Doctor (MD) in Tunis-Tunisia in the year 2007; he completed Diploma of specialist in Maxillo-Facial Surgery at Tunis-Tunisia in year 2008, and Oral Implantology & Academic diploma of Microsurgery at Lyon-France during 2008-2009. He specialized in Formation Attestation in Plastic and Aesthetic surgery (SFA), Diploma of Facial Plastic and Aesthetic Surgery, Hair Transplantation & Orthognathic Surgery at Lyon-France during 2009-2010. He was the French Board of Plastic Reconstructive and Aesthetic Surgery at Paris-France during 2010- 2011.