Scalp Reconstruction With Free Tissue Transfer as a Palliative Surgical Intervention in a High-Risk Population

Area of Science:

• Plastic Surgery
• Oncology
• Geriatric Medicine

Background:

• Microvascular scalp reconstruction is vital for patients with advanced tumors and comorbidities.
• This patient population is often elderly and medically complex, posing unique challenges.

Purpose of the Study:

• To evaluate the outcomes and safety of microvascular scalp reconstruction in a high-risk patient cohort.
• To identify risk factors for mortality and complications in these patients.

Main Methods:

• Retrospective analysis of 42 patients undergoing 45 microvascular scalp reconstructions from 2011-2021.
• Data collected included demographics, wound characteristics, operative details, and complications.
• Statistical analysis utilized univariate and multivariate models.

Main Results:

• The median patient age was 63 years, with most wounds being oncologic (84.4%) and involving deep structures (calvarium, dura).
• Flap success was high (73.3% healed, 20.0% issues with eventual success).
• Mortality was higher in patients over 70, but often related to underlying disease.

Conclusions:

• Microvascular scalp reconstruction demonstrates a high success rate in complex cases.
• It can be a valuable palliative option for elderly patients with advanced cancer and comorbidities.
• Age over 70 is a mortality risk factor, but surgical complications are not the primary driver of death.