Surgical Treatment of Radiation-Induced Late-Onset Scalp Wound in Patients Who Underwent Brain Tumor Surgery: Lessons from a Case Series.

Objective: The management of late-onset scalp wounds following irradiation is troublesome, especially in patients with a surgical history of intracranial neoplasms. It, insidiously, starts with wound dehiscence or discharge and never heals spontaneously without appropriate surgical treatment. Nevertheless, definite treatment guidelines have not yet been established. Here, we present our clinical experience with radiation-induced scalp wounds and suggest a surgical principle for their treatment. Patients and Methods. The medical records of 13 patients with brain tumors, who were treated for intractable scalp wounds after irradiation between January 2000 and August 2015, were retrospectively reviewed. All the patients underwent a craniotomy for brain tumor resection. Surgical treatment for a late-onset scalp wound was decided based on the "reconstructive ladder" and according to the status of bone flap and scalp tissue. The patients' clinical characteristics and information regarding irradiation, surgery, and postoperative complications were recorded. Results: Scalp wounds developed 4.4 years, on average, after the completion of irradiation. Revision operations were performed an average of 2.3 times, and 6 patients (46%) required more than 2 operations. The bone flap was removed in 11 patients (84.6%) to achieve complete wound healing. Among them, 3 patients underwent a cranioplasty using artificial materials, but 2 patients underwent removal due to recurrent wound problems. Conclusions: Postirradiation scalp wounds are difficult to treat and have a high risk of recurrence. If osteoradionecrosis is suspected, the bone flap should be removed. It is important to debride unhealthy tissues aggressively and cover defects with robust tissue.

External jugular veno-accompanying artery adipofascial flap: A novel and convenient flap for head and neck reconstruction.

BACKGROUND: The veno-accompanying artery adipofascial (VAF) flap is nourished by accompanying vessels near large superficial veins. We examined whether the VAF flap can be applied to the external jugular vein. METHODS: Based on anatomic and angiographic studies, we performed reconstructive surgeries using external jugular veno-accompanying artery adipofascial (EJ-VAF) flaps. A retrospective chart review was performed for all patients who underwent this surgery. RESULTS: The presence of arteries accompanying the external jugular vein was confirmed. The presence of source arteries was also confirmed. These included the occipital, facial, and superior thyroid arteries. All patients had satisfactory outcomes, except for 1 patient who had partial necrosis, which was managed using conservative treatment. CONCLUSION: Our anatomic and angiographic studies in this clinical series indicate that the EJ-VAF flap is a reliable and convenient flap. Thus, it is useful in reconstruction of small to medium head and neck defects.

Surgical Treatment and Prognosis of Angiosarcoma of the Scalp: A Retrospective Analysis of 14 Patients in a Single Institution.

OBJECTIVE: We describe specific surgical methods for angiosarcoma regarding extent of resection and reconstructive options and assess their effect on patients' prognosis. PATIENTS AND METHODS: We retrospectively examined 14 patients undergoing treatment for angiosarcoma of the scalp at our institute between January 2000 and June 2015. Surgical treatment comprised wide excision of the tumor and reconstruction using a free flap with skin graft. Kaplan-Meier survival analysis was used to assess the survival parameters. Univariate and multivariate analyses were performed to evaluate the association between risk factors and outcome parameters. RESULTS: Mean patient age at diagnosis was 69 years, and the mean follow-up period was 17 months. The overall 5- and 2-year survival rates were 15% and 75%, respectively, whereas the 5- and 2-year disease-free survival rates were 7.7% and 38.7%, respectively. The mean survival duration was 32 months. Metastatic tumor dissemination to the lung or brain was closely associated with the major cause of death. Only a deep excision margin was significantly related to the recurrence rate. CONCLUSIONS: Cases of angiosarcoma had a poor prognosis despite the aggressive treatments. Sufficient resection margins are essential for controlling local recurrence. The effect of multidisciplinary approaches needs to be explored.