Abstract

IRIBARREN BROWN, O. et al. Immediate scalp reconstruction. Cir. plást. iberolatinoam. [online]. 2006, vol.32, n.1, pp.55-62. ISSN 1989-2055.

We present sucessive cases performed at Surgery Department of Hospital San Pablo, Coquimbo, Chile, between April1998, and April 2005: Twenty two consecutive patients suffering surgical or postinjury scalp defects, greater than 3 cm of diameter. Semilunar flap, mirror flap, or multiple pinwheel flap arterialized from the main scalp arteries were used for reconstruction. We determinate in every case the large of the defect, asociated bone loss, kind of surgery, end result and complications. Patients’ mean age was 40.6 years with rank between 3 and 71 years old. The involved anatomical area was parietal on 11 patients, (50 %), temporal in 7 cases (31.8 %), occipital in 3 cases (13.6 %) and frontal 1 case, (4.5 %). The origin of scalp loss was malign or benign tumor resection in 10 patients, post injury 5 cases, secondary to neurosurgical procedures in 4 cases, and alopecia or baldness in 3 cases. The mean large of the defect was 147 cm² with rank between 28 and 615 cms² . The mirror flap was used in 10 cases (50 %), the sliding semilunar flap in 9 patients (36.4 %), and the multiple pinwheel flap in 3 patients (13.6 %). An aditional dermoepidermal graft was used on 6 patients to cover a small area of flap donor site (two mirror flaps, and two semilunar flaps). Patients’ evolution were without complications in 95 % of cases (21/22). One woman with a temporal bone necrosis after two craniotomies suffered a distal flap necrosis, and finally died due aspirative pneumonia. The three kind of flap were compared according the defect length and defect area. The Kruskal Wallis test shows that the mean length and mean area of three different flap are statistically similars. The choice of one flap or another is no related with the area of the defect, p > 0.05. The main reason for choosing the flap was the site defect. Conclutions: the immediate scalp reconstruction strategie by arterialized flaps allows to close big defects, in one step, by a relatively simple technique with hidden scars under hair. We think this procedure is the best choice for immediate scalp recostruction, and we recommend its usage because this technique has reliable outcome when the surgical team follows the technical principles of flaps handle.

Keywords : Scalp; Flaps; Código numérico.

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