This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Facial Plastic Surgery  • Reconstructive Facial Surgery  • Alert me on articles by topic

Nigel J. P. Beasley, MB; Ralph W. Gilbert, MD; Patrick J. Gullane, MB; Dale H. Brown, MD; Jonathan C. Irish, MD, FRCSC; Peter C. Neligan, MB

Arch Facial Plast Surg. 2004;6:16-20.

Objective  To examine the indications for, and the success of, free flap reconstruction in patients with forehead and scalp defects.

Design  Case series.

Setting  Two tertiary referral university teaching hospitals.

Patients  Twenty-six consecutive patients, aged 31 to 85 years, presenting with 26 scalp defects, 5 forehead defects, and 1 combined defect (size, 70-672 cm²). Three patients required resection and repair of the dura at surgery.

Intervention  Patients were staged according to the size of the defect and the viability of surrounding tissue; free flap reconstruction was performed where indicated.

Main Outcome Measures  Flap survival, complications, and disease-free and overall survival.

Results  Thirty-four free flap reconstructions were performed (24 latissimus dorsi free flaps, 4 scapular free flaps, 3 rectus abdominis free flaps, and 3 radial forearm free flaps). One failed 2 weeks postoperatively, and 2 required exploration (1 for arterial ischemia and 1 for a hematoma). There were 3 cases of donor site morbidity (2 early seromas and 1 late abdominal hernia). One patient died of a pulmonary embolus 1 week postoperatively. Disease-free survival was 48% at 5 years and overall survival was 59% at 5 years, with a median follow-up of 24 months.

Conclusions  Free revascularized tissue transfer is a reliable and safe way of reconstructing large scalp or forehead defects after traumatic injury or neoplastic resection. The muscle-only latissimus dorsi free flap for scalp reconstruction and the cutaneous scapular free flap for the forehead have proved successful in selected patients with a low complication rate and satisfactory cosmesis.

From the Wharton Head and Neck Centre, Princess Margaret Hospital, Toronto, Ontario.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Update on Major Reconstruction of the Head and Neck
Wax et al.
Arch Facial Plast Surg 2007;9:392-399.
ABSTRACT | FULL TEXT  

Evaluation of Facial Allograft Transplantation in Humans in a Cadaver
Wax and Genden
Arch Facial Plast Surg 2007;9:366-368.
FULL TEXT