Pedicled Scalp Reconstruction After Radiation Therapy

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncology

Background:

• Reconstructing large scalp defects after external beam radiation therapy (EBRT) is challenging due to compromised vascularity and poor healing.
• Pedicled scalp flaps offer a potentially simpler alternative to free tissue transfer for selected patients.
• This study evaluates pedicled scalp flap outcomes in irradiated patients with significant scalp defects.

Purpose of the Study:

• To assess the reliability of pedicled scalp flaps for large scalp defect reconstruction in patients with prior EBRT.
• To identify risk factors associated with pedicled scalp flap complications in this patient population.

Main Methods:

• Retrospective review of 216 patients treated between January 1998 and December 2024.
• Inclusion criteria: prior EBRT, scalp defect size ≥15 cm², pedicled scalp flap use, and ≥6 months follow-up.
• Data collected: demographics, prior surgeries, reconstruction indications, flap design, complications, survival, and reoperations.

Main Results:

• Complete healing occurred in 87.5% of patients (189/216).
• Complications included wound breakdown (16 patients), partial flap loss (8 patients), and major flap loss (3 patients).
• A history of prior scalp flaps was associated with increased risk of partial or major flap loss.

Conclusions:

• Pedicled scalp flaps are a reliable reconstructive choice for large defects in irradiated patients when vascular principles are respected.
• Prior scalp flap history is a significant risk factor for flap loss and should guide surgical planning.
• These findings support the use of pedicled scalp flaps in this challenging patient group.