Application of a jigsaw puzzle flap based on free-style perforator to repair large scalp defects after tumor resection: A case series

Background

Reconstruction of large scalp defects after tumor resection is common and challenging. Free skin grafting or free flap transfer is always performed. However, these techniques can result in poor functional and cosmetic outcomes.

Methods

In the Second Affiliated Hospital of Soochow University and the Second Affiliated Hospital of Chengdu Medical College, 35 patients underwent jigsaw puzzle flap procedures based on a free-style perforator to repair large scalp defects after tumor resection from May 2013 to November 2022. The key to this procedure was to divide a large defect into several smaller parts that correspond to adjacent free-style perforators around the scalp defect. The free-style perforator flaps were designed in different ways, such as propeller flaps, rotation flaps, and V-Y advancement flaps, which were pedicled with free-style perforators. All of the small flaps were then mobilized to the defect and sutured to each other to create a new, large jigsaw puzzle-like flap to cover the large scalp defect. Finally, all the donor sites were closed directly.

Results

Overall, 35 patients were treated. The average defect size was 72 ​cm² (range, 25–91 ​cm²). All flaps had a satisfactory appearance after follow-up periods of 6 months–10 years. Local tumor recurrence occurred in one case.

Conclusion

The application of a jigsaw puzzle flap based on a free-style perforator is a suitable option for the reconstruction of large scalp defects after resection, yielding satisfactory functional and cosmetic results.