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Defect Size, Depth, Patient Factors Affect Scalp Reconstruction Choice

by Amy E. Hamaker •

What are the factors that influence the choice of technique and complications of scalp reconstruction after oncologic ablation?

Background: Scalp defects can be produced through a number of conditions and treatments. Scalp reconstruction following oncologic resection presents a particularly difficult situation for both patient and surgeon given the urgency of ablation and uncertainty in final defect size. There are currently few objective data on reconstructive outcomes and what factors may play a role in complications and reconstructive failures.

Study design: Single-institution retrospective review of 139 patients who required oncologic scalp resection with subsequent reconstruction between 1992 and 2010.

Setting: Mayo Clinic, Rochester, Minn.

Synopsis: The majority of the patients were males aged 60 to 70. Thirty-five had undergone a previous resection and presented for completion resection, 18 had undergone Mohs’ micrographic surgery and were referred for reconstruction of a complex defect, and the remainder had primary wide local excision and reconstruction in a single stage. Approximately two-thirds of the defects were reconstructed using simple techniques; the remainder required more advanced reconstruction. Fifteen complications total were identified: three major and 12 minor. Scalp defect depth was correlated with and size was significantly associated with increased complication rate. Reconstruction type did not significantly affect complication rates. Patients with a history of pre-operative head and neck radiation exposure had a significantly higher complication rate. Other factors affecting wound healing were not significantly associated with increased complication rates, but the data on whether diabetes mellitus or hypothyroidism were under good control were inconsistent.

Bottom line: Larger and deeper defects, and factors including pre-operative radiation and immunosuppression, are more prone to wound complications.

Citation: Janus JR, Peck BW, Tombers NM, Price DL, Moore EJ. Complications after oncologic scalp reconstruction: A 139-patient series and treatment algorithm. Laryngoscope. 2015;125:582-588.