Microsurgical Reconstruction of Complex Scalp Defects With Vastus Lateralis Free Flap.

Area of Science:

• Plastic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Scalp reconstruction presents significant challenges for plastic surgeons, often necessitating microsurgical-free flaps for large or complex defects.
• Reconstructive failure in scalp defects can lead to severe morbidity and life-threatening complications.

Purpose of the Study:

• To evaluate the efficacy and safety of the vastus lateralis (VL) free flap in reconstructing complex scalp defects.
• To analyze patient outcomes, including complications and satisfaction, following VL free flap reconstruction.

Main Methods:

• Retrospective analysis of 30 patients undergoing scalp soft tissue reconstruction with a VL free flap between July 2013 and July 2023.
• Data collected included patient demographics, clinical and surgical characteristics, and postoperative complications.
• Vastus lateralis free flaps were used for all soft tissue reconstructions, with skin-grafted muscular flaps utilized in 28 cases.

Main Results:

• Thirty patients (mean age 67.3 years; 17 male, 13 female) with complex scalp defects (26 involving bone/dura) underwent reconstruction.
• Defects primarily resulted from cancer resection (56.7%).
• Complications occurred in 20% of patients (two flap losses, two cranioplasty infections). Two patients died within 48 hours. All patients reported satisfaction at 6 months.

Conclusions:

• The vastus lateralis (VL) free flap is a reliable option for complex scalp reconstruction, offering low donor site morbidity and facilitating a two-team approach.
• This microsurgical technique provides well-vascularized tissue, effectively covers large defects, reduces infection risk, and ensures adequate brain protection.
• VL free flap reconstruction leads to good aesthetic and functional results, with high patient satisfaction.