Study of Management of Scalp Defect- Our Experience in a Tertiary Care Center of Vindhya Region, a Remote Area of MP.

Aetiology of the scalp defects may be burns, trauma, avulsion, infection, resection for neoplasm or congenital defects, the goals & principles are similar, and their repair is dependent upon their location, size and depth. In the case of the scalp, the repair of even small defects is complicated. We wanted to assess the epidemiology, etiological factors, type and site of distribution, various modalities, overall cosmetic effect and function of both donor as well as recipient sites of scalp defects. We also wanted to evaluate the epidemiological and aetiological factors influencing the various modalities of scalp defect management and the overall cosmetic effect on both donor as well as recipient site. METHODSA descriptive study was conducted at Sham Shah Medical College and associated SGM Hospital, Rewa, which is also known as Vindhya region of Madhya Pradesh. A total of 44 cases of scalp defects, that were treated in the department of surgery over a period of 18 months from May 2018 to November 2019 constitute the material of this study. Patients were included in the study after obtaining an informed consent. One-year follow-up of the patients was done, RESULTS26 cases [59.01%] of scalp defect were repaired with transposition flap; rotation flap was done in 2 cases [4.45%], bipedicled flap was done in 2 cases [4.45%], double opposing rotational flap was done in 01 case [2.27], S.T.G. was done in 7 cases [15.9%], and primary closure was done in 6 cases [13.63%]. In our study 59.09% cases are due to trauma and occur in second to fourth decade out of which 26 patients have exposed bone, and out of 26 patients, 09 patients have fracture of bone. CONCLUSIONSScalp reconstruction depends on the nature and the region of the defect. A range of reconstruction techniques have been described. The quality of the residual scalp is critical for performing a local flap. Local flaps are the reference for the reconstruction of such defects. Knowledge of scalp anatomy is essential for preparing these flaps. The parietal zone is the location offering the greatest flap mobilization possibilities. A review is provided of the different techniques for the reconstruction of large scalp defects.

A case of recurrent porocarcinoma of the scalp requiring scalp reconstruction

Eccrine porocarcinoma (EPC) is a rare malignant tumour, first reported by Pinkus and Mehregan in 1963. It can develop from the eccrine duct epithelial component or transform from an underlying eccrine poroma. The tumor usually presents as an exophytic growth and has a female predilection. Rarely it can occur in scalp, face, ear, genitalia and eye lids. Treatment modalities have included standard excision, Mohs micrographic surgery, chemotherapy, and radiation therapy. Therapy of choice is surgical excision with clear margins with 70-80% cure rates. Chemotherapy is of no known significance and radiation might help in selective cases. Majority of cases are managed with excision and closure of defects but in selective cases there may be need to reconstruct the scalp defects. The methods of reconstruction may be local flaps, free tissue transfer and partial/full thickness skin grafts. Regional flaps are very useful in patients requiring cover of large defects.

Transposition flaps: a valid option for reconstruction of soft tissue defects of scalp

Background: The scalp wounds are becoming increasingly common as a result of high-speed automobile accidents, fall from heights and others. Scalp reconstruction is a challenge for plastic surgeons. Minor wounds heal of themselves, but some wounds need some type of intervention in the form of reconstruction. Authors have raised flaps in unconventional measurements.Methods: Authors have incorporated 19 patients in this study over a period of one year. Extensive surgical procedures like burring of the skull bones and patients with comorbid conditions were not included. Authors simply rely on local flaps preferably transposition flaps to cover mainly the exposed skull bones. All the flaps were raised leaving the galea intact. The secondary defects were always skin grafted with split skin graft taken from thigh. Authors have raised random flaps in unconventional dimensions showing that a large random flap can be raised on a single vessel with good results.Results: All the wounds healed well without significant complications. So, this method of reconstruction can be applied to even large defects where very sophisticated services are not available.Conclusions: This method of reconstruction can be applied to even very large defects where very sophisticated microvascular services and expertise are not available with appreciably good results.

Surgical feed ligation performed in 22 year old female with scalp arteriovenous malformation

Scalp arteriovenous malformation (AVM) are rare conditions that usually need surgical treatment. Its management is difficult because of its high shunt flow, complex vascular anatomy, and possible cosmetic complication. The etiology of scalp AVM may be spontaneous or traumatic. This vascular lesion present as scalp lump or a mass, grotesque, pulsatile mass with a propensity to massive haemorrhage. Various treatment option that have been adopted to treat these lesions include surgical excision, ligation of feeding vessel, trans arterial and transvenous embolization, injection of sclerosant into the nidus and electro thrombosis. A 22-years-old-female referred to cardiothoracic division with a 10 years history of a large fronto-parietal pulsatile reddish soft mass, progressively increasing in size, measuring about 15x6x2 cm, ulcerated area; without any symptoms and history of trauma. Three-dimensional CT angiography demonstrated a mass that was completely within the scalp and prominent vascular that was completely within the scalp and was not associated with bone or periosteum. The feeding arteries were originated from angular artery, supratrochlear artery, left and right superficial temporal artery. Surgical excision and ligation of feeding vessel was performed without complication. With pre-operative appropriate surgical planning, scalp AVM can be excised safely without any major complication. Though some cases may be treated with percutaneous or endovascular embolization, surgery remains the treatment of choice. In the event of scalp ulceration and haemorrhage, total excision is the only option.

Immediate Near-Total Scalp Reconstruction with Artificial Dermis on Exposed Calvarium

Scalp defect management is complicated secondary to reduced laxity in the scalp and forehead area. For reconstruction of larger defects with exposed bone and loss of the periosteal layer, free flap reconstruction is one option for single-stage surgery, although the procedure is lengthy and includes the possibility of flap loss. We successfully performed a single-stage reconstruction of a large scalp defect using a combination of artificial dermis, split-thickness skin graft, and full-thickness skin graft following wide excision of a cutaneous angiosarcoma, and present our method as one option for the treatment of large oncologic surgical defects in patients who are poor candidates for free flap surgery.

Scalp Wound Closure with K wires: An alternative easier method to scalp wound closure

Scalp defects and lacerations present a reconstructive challenge to plastic surgeons. Many methods have been described from the use of skin grafting to rotation flaps. Here we present a method of closure of a contaminated scalp wound with the use of Kirschner wires. In our case, closure of scalp laceration was made possible with the use of 1.4 Kirschner wires and cable tie/ zip tie fasteners. The duration to closure of wound was 10 days. In reconstructing the scalp defect, this method was found to adhere to principles of scalp reconstruction. There were no post operative complications found from the procedure. On initial application on the edge of the wound, tension applied caused the K wires to cut through the wound edge. On replacement of K wires 1cm away from wound edge the procedure was not plagued by any further complication. In conclusion we find scalp closure with Kirschner wires are a simple and effective method for scalp wound closure.