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Facial Plastic and Reconstructive Surgery

Microvascular Free-Flap Reconstruction of Complex Scalp Defects

Wednesday, October 4, 2023
10:54 AM - 11:00 AM East Coast USA Time
Location: 205ABC

    Presenting Author(s)

  • Dev R. Amin, MD

    Resident Physician
    Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

    • Co-Author(s)

  • Daniel J. Campbell, MD

    Resident Physician
    Thomas Jefferson University Hospital
    Philadelphia, PA, United States

  • Ramez Philips, MD

    Medical Student
    Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital
    Philadelphia, Pennsylvania, United States

  • EM

    Eric V. Mastrolonardo, MD

    Resident
    Thomas Jefferson University Hospital
    Philadelphia, PA, United States

  • Aarti M. Agarwal, MD

    Resident Physician
    Thomas Jefferson University
    Philadelphia, PA, United States

    • Senior Author(s)

  • RH

    Ryan N. Heffelfinger, MD

    Professor, Department of Otolaryngology - Head and Neck Surgery Director, Division of Facial Plastic and Reconstructive Surgery
    Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery
    Philadelphia, PA, United States

  • Joseph M. Curry, MD

    Professor
    Thomas Jefferson University Hospital
    Wynnewood, PA, United States

Disclosure(s):
Daniel J. Campbell, MD: No relevant relationships to disclose.
Eric V. Mastrolonardo, MD: No relevant relationships to disclose.
Introduction: Complex scalp defects requiring microvascular free flap reconstruction may be at increased risk of long term wound breakdown due to flap atrophy, particularly of muscular components devoid of innervation. This investigation compares operative characteristics and surgical complications of fasciocutaneous anterolateral thigh free flaps (ALTFF) versus myofascial latissimus dorsi free flaps (LDFF) with skin grafting for reconstruction of complex scalp defects.

Methods: A retrospective review of patients undergoing reconstruction of the scalp with fasciocutaneous ALTFF or myofascial LDFF with skin grafting at a single tertiary-care institution between 2007 and 2021. Factors examined include demographics; operative characteristics such as defect features, plating, operative duration, and intraoperative flap compromise; and surgical complications. Primary outcomes examined included scalp wound breakdown and need for revision reconstructive procedure.

Results: 46 patients met inclusion criteria (ALTFF = 25, LDFF = 21). There were no differences in age, gender, comorbidities, or operative characteristics between groups. Reconstruction with LDFF correlated with greater defect area (p < 0.001) but not with defect depth. Reconstruction with ALTFF was associated with decreased operative duration (p=0.021) and decreased length of hospital stay (p=0.032). There were no differences in surgical complication rates between groups. Multivariate analysis of reconstructive outcomes 6 months or greater from surgery demonstrated ALTFF were less likely to need revision reconstructive procedures (p=0.047) after adjusting for confounders such as defect size and adjuvant radiation.

Conclusions: The fasciocutaneous ATLFF may offer a more effective reconstructive option for complex scalp defects than the myofascial LDFF with skin grafting. Reconstruction with ALTFF was associated with fewer future reconstructive interventions related to long term wound breakdown. Further, ALTFF reconstruction was associated with decreased operative time and length of stay with no difference in surgical complications.