EVALUATION OF LOCAL AXIAL FLAPS IN SCALP DEFECTS RECONSTRUCTION

Abstract

Background: The scalp consists of specialized tissue composed of dense hair follicles and inelastic thick galea aponeurotica, unlike other tissues of the body. Reconstruction of the scalp can be challenging because of the convexity of the underlying skeleton, the inelasticity of the galea, and the paucity of the adjacent tissue, which make even small defects difficult to close. Objective: To evaluate the local axial flaps used in reconstruction of the different scalp defects in terms of feeding vessels, arc of rotation, and flap dimensions. Patients and Methods: Twenty patients between 5-68 years old who had medium to huge scalp defects caused by burn, trauma and malignancy were subjected to this study at Al-Azhar University Hospitals (Al-Hussein and Al-Sayed Galal) to evaluate the effect of local axial flaps in them in terms of stable coverage of the defects with similar hair-bearing tissue, re-creation of the hairline, matching skin thickness, color and minimal donor site morbidity. Results: Non-expanded rotational and expanded advancement flap were the most used flaps, and the least used was the transposition flap. Minor complications included: seroma happened in 3 patients (25.0%) and graft loss in 2 patients (10%). Distal flap necrosis occurred in 3 patients (15%), TE Exposure in 2 patients (10%), wound dehiscence in 2 patients (10%), and ischemic necrosis of skin over the expander happened in 1 patient (5%). Conclusion: Reconstruction of scalp defects with local flaps is a safe, relatively short and simple procedure unlikely to cause any major complications or demand special postoperative care. In cranial or dural defect, a local scalp flap is the reconstructive method of choice. Application of local axial flaps indicates that complications were quite rare and did not extensively affect the survival of the flaps.