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Qureshi AA, Kirsner RS. Evidence-Based Review of Clinical Applications and Outcomes of Automated Epidermal Grafting. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00270-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Steiner D, Horch RE, Eyüpoglu I, Buchfelder M, Arkudas A, Schmitz M, Ludolph I, Beier JP, Boos AM. Reconstruction of composite defects of the scalp and neurocranium-a treatment algorithm from local flaps to combined AV loop free flap reconstruction. World J Surg Oncol 2018; 16:217. [PMID: 30404625 PMCID: PMC6223072 DOI: 10.1186/s12957-018-1517-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/24/2018] [Indexed: 11/22/2022] Open
Abstract
Background Reconstruction of cranial composite defects, including all layers of the scalp and the neurocranium, poses an interdisciplinary challenge. Especially after multiple previous operations and/or radiation therapy, sufficient reconstruction is often only possible using microsurgical free flap transplantation. The aim of this study was to analyze the therapy of interdisciplinary cases with composite defects including the scalp and neurocranium. Methods From 2009 to 2017, 23 patients with 18 free flaps and 10 pedicled/local flaps were analyzed. First choices for free flaps were muscle flaps followed by fasciocutaneous flaps. Results Except for four patients, a stable coverage could be reached in the first operation. Three of these patients received a local scalp rotation flap in the first operation and needed an additional free flap because the local flap was no longer sufficient for coverage after wound healing deficiency or tumor relapse. The superficial temporal artery or external carotid artery served as recipient vessels. In special cases, venous grafts or an arteriovenous loop (AV loop) were used as extensions for the recipient vessels. Conclusions In summary, an interdisciplinary approach with radical debridement of infected or necrotic tissue and the reconstruction of the dura mater are essential to reach a stable, long-lasting reconstructive result. Based on our experience, free flaps seem to be the first choice for patients after multiple previous operations and/or radiation therapy.
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Affiliation(s)
- Dominik Steiner
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany.
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany.
| | - Ilker Eyüpoglu
- Department of Neurosurgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Marweh Schmitz
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Justus P Beier
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department of Plastic Surgery, Hand and Burn Surgery, University Hospital RWTH Aachen, RWTH, Aachen, Germany
| | - Anja M Boos
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Krankenhausstr. 12, 91054, Erlangen, Germany.,Department of Plastic Surgery, Hand and Burn Surgery, University Hospital RWTH Aachen, RWTH, Aachen, Germany
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