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Scalp reconstruction: an algorithmic approach and systematic review.

Shaun C Desai1, Jordan P Sand1, Jeffrey D Sharon1

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Scalp reconstruction for acquired defects, especially post-radiation, requires careful consideration of defect size, location, and patient factors. Free tissue transfer is often optimal for larger defects in irradiated areas.

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Surgical Oncology

Background:

  • Scalp reconstruction presents a significant challenge, particularly in patients with prior radiation therapy.
  • Acquired scalp defects necessitate tailored reconstructive approaches for optimal outcomes.

Purpose of the Study:

  • To present a novel algorithm for guiding scalp reconstruction decisions.
  • To review literature on scalp reconstruction, considering cosmetic and functional aspects.
  • To discuss surgical anatomy, patient selection, and reconstructive techniques.

Main Methods:

  • Comprehensive literature search of PubMed and Medline for scalp reconstruction studies.
  • Prioritization of evidence-based studies with higher levels of evidence.
  • Analysis of factors influencing reconstructive technique selection.

Main Results:

  • Key factors for ideal reconstruction include defect size, location, radiation history, and hairline distortion potential.
  • Scalp laxity influences the feasibility of primary or local flap closures.
  • Free tissue transfer is recommended for medium to large defects in irradiated patients.

Conclusions:

  • Optimal scalp reconstruction demands understanding of anatomy, surgical techniques, and patient-specific factors.
  • The simplest effective method should be prioritized for functional and aesthetic results.
  • A systematic approach ensures the best functional and aesthetic scalp reconstruction.