Robot-assisted Free Omental Flap for Scalp Reconstruction

Scalp reconstruction can be challenging when there is significant tissue loss. We report a staged reconstruction using an omental free flap with a novel recipient vessel and split-thickness skin graft for a full-thickness scalp defect with exposed calvaria. A 64-year-old woman presented to a level 1 trauma center with severe scalp and right face avulsion injuries after being mauled by a dog. At the initial debridement, her scalp was non-salvageable and was subsequently treated with staged reconstruction using an omental free flap with the middle temporal artery as the recipient conduit and a split-thickness skin graft. She retained stable scalp coverage at 26 months postoperatively. The omental flap offers a promising option to recreate a protective soft-tissue covering of the calvaria with limited patient morbidity compared with conventional free-flap options. Although laparoscopic harvest of this flap has been described, limited literature exists with respect to robotic omental flap harvest and its associated outcomes. Additionally, in the setting of severe trauma, the usual recipient vessels for microvascular anastomosis can be damaged due to the zone of injury. The middle temporal artery provides an alternative when the standard conduit (ie, the superficial temporal artery) is unavailable. We report a unique case of traumatic scalp avulsion following a dog attack requiring staged reconstruction with a robot-assisted omental free flap and split-thickness skin graft, demonstrating the feasibility of robotic omental flap harvest and the use of an alternative recipient vessel for microvascular anastomosis.