Madelyn Stroder1, Jeffrey S Litt2, N Scott Litofsky3. 1. Division of Neurological Surgery, University of Missouri School of Medicine, One Hospital Drive, MC 321, Columbia, Missouri. 2. Division of Acute Care Surgery, University of Missouri School of Medicine, One Hospital Drive, Columbia, Missouri. 3. Division of Neurological Surgery, University of Missouri School of Medicine, One Hospital Drive, MC 321, Columbia, Missouri. Electronic address: litofskyn@health.missouri.edu.
Abstract
INTRODUCTION: Patients can develop scalp and cranial defects as a result of neoplasm, trauma, or infection. Reconstruction of these defects can be difficult in some patients and may require a multidisciplinary approach using creative solutions usually used for disease processes in other areas of the body, such as severe burns. METHODS: A series of nine patients were treated using multidisciplinary techniques for reconstruction of complex cranial and scalp defects. Data on patient characteristics, initial treatment, preparatory and definitive reconstructive treatment were retrospectively collected. Outcomes were measured as full solution, partial solution, or failure. RESULTS: Three patients had a full solution/wound closure, five had a partial solution, and one failed reconstructive attempt. Full solution patients tended to be younger, received reconstruction treatment modalities for longer periods of time, and had more definitive surgeries. Initial and preparatory surgeries did not tend to promote a full solution, though having fewer preparatory surgeries that were not related to wound VAC use tended to be associated with a better outcome. Infection of the scalp or cranium did not tend change the result. CONCLUSION: Reconstructive salvage of complex cranial and scalp defects takes time, so patience and earlier recognition of need for atypical reconstruction is beneficial. Patient characteristics may influence outcomes, but judicious choice of materials and techniques is more critical to patient success. Use of a multidisciplinary approach to complex cranial and scalp reconstruction is a beneficial option for many patients for whom standard reconstruction methods are not viable.
INTRODUCTION:Patients can develop scalp and cranial defects as a result of neoplasm, trauma, or infection. Reconstruction of these defects can be difficult in some patients and may require a multidisciplinary approach using creative solutions usually used for disease processes in other areas of the body, such as severe burns. METHODS: A series of nine patients were treated using multidisciplinary techniques for reconstruction of complex cranial and scalp defects. Data on patient characteristics, initial treatment, preparatory and definitive reconstructive treatment were retrospectively collected. Outcomes were measured as full solution, partial solution, or failure. RESULTS: Three patients had a full solution/wound closure, five had a partial solution, and one failed reconstructive attempt. Full solution patients tended to be younger, received reconstruction treatment modalities for longer periods of time, and had more definitive surgeries. Initial and preparatory surgeries did not tend to promote a full solution, though having fewer preparatory surgeries that were not related to wound VAC use tended to be associated with a better outcome. Infection of the scalp or cranium did not tend change the result. CONCLUSION: Reconstructive salvage of complex cranial and scalp defects takes time, so patience and earlier recognition of need for atypical reconstruction is beneficial. Patient characteristics may influence outcomes, but judicious choice of materials and techniques is more critical to patient success. Use of a multidisciplinary approach to complex cranial and scalp reconstruction is a beneficial option for many patients for whom standard reconstruction methods are not viable.